Objective:To investigate the prognostic differences between endobronchial and invasive bronchial characteristics in patients with non-small cell lung cancer (NSCLC) undergoing sleeve lobectomy.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on clinical data of 200 NSCLC patients who underwent sleeve lobectomy at the Department of Thoracic Surgery, Shanghai Pulmonary Hospital between January 2014 and December 2016. There were 181 males and 19 females, aged (61.3±8.1) years (range: 30 to 81 years). Based on imaging data, they were divided into the endobronchial group ( n=71) and the invasive bronchial group ( n=129). Clinical data and prognosis were collected and analyzed. Sex, age, hypertension, diabetes, smoking history, pathology type, tumor size, staging, surgical method, surgical site, and sleeve technique were included as covariates. Propensity score matching was performed with a 1∶1 ratio between the endobronchial and invasive bronchial groups using the nearest-neighbor matching method. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was applied to compare differences between groups. Independent sample t tests, Mann-Whitney U tests, χ2 tests, or Fisher′s exact tests was used for group comparisons. Results:After propensity score matching, 71 cases from each group (endobronchial and invasive bronchial) were included, with no significant differences in baseline characteristics between the two groups (all P>0.05). Endobronchial group showed significantly better overall survival (OS) and disease-free survival (DFS) compared to invasive bronchial group(Log-rank test: P=0.014,0.027). Further subgroup analysis revealed that in the minimally invasive surgery subgroup, the DFS of the endobronchial group was significantly better than that of the invasive bronchial group (Log-rank test: P=0.002), while in the open thoracotomy subgroup, there was no significant difference in DFS between the two groups (Log-rank test: P=0.290). In the right upper lobe sleeve resection subgroup, the endobronchial group had significantly better DFS than the invasive bronchial group (Log-rank test: P=0.039). For patients in the stage Ⅱ to Ⅲ subgroup, the endobronchial group had significantly better DFS than the invasive bronchial group (Log-rank test: P=0.005). Conclusion:In sleeve lobectomy, patients with endobronchial NSCLC have better OS and DFS compared to those with invasive bronchial type, particularly in patients undergoing minimally invasive surgery, right upper lobe sleeve lobectomy, and stage Ⅱ to Ⅲ patients.

Stage ⅠB non-small cell lung cancer (NSCLC), a potentially curable malignancy, continues to exhibit a substantial recurrence rate post-surgery. Targeted therapy has significantly improved the prognosis of patients with advanced epidermal growth factor receptor mutation (EGFRm), while the need and optimal timing for adjuvant targeted therapy in epidermal growth factor receptor mutant (EGFRm) stage ⅠB patients remain unclear. This review systematically examines the advancements of adjuvant targeted therapy in stage ⅠB EGFRm NSCLC and critically explores the practical problems in its clinical application. Third-generation targeted agents, such as Osimertinib, have significantly improved disease-free survival in stage ⅠB EGFRm NSCLC according to the seventh edition of the TNM staging system. However, the survival benefits in this population based on the eighth/ninth edition staging systems have yet to be fully validated, and stage ⅠB NSCLC patients exhibit different treatment response patterns. Consequently, current research focuses on high-risk subgroups to optimize treatment outcomes. Major clinical challenges include acquired resistance, determining the optimal treatment timing, and implementing individualized treatment strategies. Future research should concentrate on elucidating the mechanisms of resistance, optimizing treatment timing, establishing precise risk stratification systems, and exploring personalized treatment strategies guided by dynamic monitoring of circulating tumor DNA. This review aims to provide a comprehensive analysis of these key issues and offer a theoretical foundation for optimizing the clinical practice of adjuvant targeted therapy in stage ⅠB NSCLC.

Stage ⅠB non-small cell lung cancer (NSCLC), a potentially curable malignancy, continues to exhibit a substantial recurrence rate post-surgery. Targeted therapy has significantly improved the prognosis of patients with advanced epidermal growth factor receptor mutation (EGFRm), while the need and optimal timing for adjuvant targeted therapy in epidermal growth factor receptor mutant (EGFRm) stage ⅠB patients remain unclear. This review systematically examines the advancements of adjuvant targeted therapy in stage ⅠB EGFRm NSCLC and critically explores the practical problems in its clinical application. Third-generation targeted agents, such as Osimertinib, have significantly improved disease-free survival in stage ⅠB EGFRm NSCLC according to the seventh edition of the TNM staging system. However, the survival benefits in this population based on the eighth/ninth edition staging systems have yet to be fully validated, and stage ⅠB NSCLC patients exhibit different treatment response patterns. Consequently, current research focuses on high-risk subgroups to optimize treatment outcomes. Major clinical challenges include acquired resistance, determining the optimal treatment timing, and implementing individualized treatment strategies. Future research should concentrate on elucidating the mechanisms of resistance, optimizing treatment timing, establishing precise risk stratification systems, and exploring personalized treatment strategies guided by dynamic monitoring of circulating tumor DNA. This review aims to provide a comprehensive analysis of these key issues and offer a theoretical foundation for optimizing the clinical practice of adjuvant targeted therapy in stage ⅠB NSCLC.

Objective:To investigate the prognostic differences between endobronchial and invasive bronchial characteristics in patients with non-small cell lung cancer (NSCLC) undergoing sleeve lobectomy.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on clinical data of 200 NSCLC patients who underwent sleeve lobectomy at the Department of Thoracic Surgery, Shanghai Pulmonary Hospital between January 2014 and December 2016. There were 181 males and 19 females, aged (61.3±8.1) years (range: 30 to 81 years). Based on imaging data, they were divided into the endobronchial group ( n=71) and the invasive bronchial group ( n=129). Clinical data and prognosis were collected and analyzed. Sex, age, hypertension, diabetes, smoking history, pathology type, tumor size, staging, surgical method, surgical site, and sleeve technique were included as covariates. Propensity score matching was performed with a 1∶1 ratio between the endobronchial and invasive bronchial groups using the nearest-neighbor matching method. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was applied to compare differences between groups. Independent sample t tests, Mann-Whitney U tests, χ2 tests, or Fisher′s exact tests was used for group comparisons. Results:After propensity score matching, 71 cases from each group (endobronchial and invasive bronchial) were included, with no significant differences in baseline characteristics between the two groups (all P>0.05). Endobronchial group showed significantly better overall survival (OS) and disease-free survival (DFS) compared to invasive bronchial group(Log-rank test: P=0.014,0.027). Further subgroup analysis revealed that in the minimally invasive surgery subgroup, the DFS of the endobronchial group was significantly better than that of the invasive bronchial group (Log-rank test: P=0.002), while in the open thoracotomy subgroup, there was no significant difference in DFS between the two groups (Log-rank test: P=0.290). In the right upper lobe sleeve resection subgroup, the endobronchial group had significantly better DFS than the invasive bronchial group (Log-rank test: P=0.039). For patients in the stage Ⅱ to Ⅲ subgroup, the endobronchial group had significantly better DFS than the invasive bronchial group (Log-rank test: P=0.005). Conclusion:In sleeve lobectomy, patients with endobronchial NSCLC have better OS and DFS compared to those with invasive bronchial type, particularly in patients undergoing minimally invasive surgery, right upper lobe sleeve lobectomy, and stage Ⅱ to Ⅲ patients.

Lung cancer, one of the most prevalent cancer types globally, underscores the critical importance of early detection and precise diagnosis in its management. However, conventional pathological diagnostic methods encounter various limitations, including the intricacies of the diagnostic process and the challenges in achieving uniform results. In contrast to traditional pathology, digital pathology integrates digitized pathological information with artificial intelligence, and offers a pathway for rapid and accurate diagnostic assistance. It holds the potential to delve into the tumor characteristics and microenvironment information, thereby supporting precision diagnosis and treatment for lung cancer. This article elucidates the recent applications of digital pathology in lung cancer diagnosis, staging, treatment, and prognosis. Additionally, it addresses the challenges currently faced by digital pathology.

With the change of coronavirus disease 2019 (COVID-19) prevention and control strategy in China, the number of COVID-19 cases has increased significantly recently, which has also brought new challenges to the perioperative risk control of thoracic surgery. This paper puts forward several suggestions, aiming to standardize the preoperative screening and evaluation during the COVID-19 period, strictly grasp the indications and timing of surgery, optimize the medical management process, individualize surgical decision-making, and minimize the risk of COVID-19 infection to surgery.

With the change of COVID-19 prevention and control strategy in China, the number of COVID-19 cases has increased significantly recently, which has also brought new challenges to the perioperative risk control of thoracic surgery. This paper puts forward several suggestions, aiming to standardize the preoperative screening and evaluation during the COVID-19 period, strictly grasp the indications and timing of surgery, optimize the medical management process, individualize surgical decision-making, and minimize the risk of COVID-19 infection to surgery.

Malignant pleural mesothelioma(MPM) is a kind of rare and aggressive malignant neoplasm. Surgery plays one of the most important roles in the treatment of MPM. However, due to the high morbidity and mortality reported, the survival benefit and indication of surgery are still controversial. This article will review the surgical indications, discuss and compare the roles of extrapleural pneumonectomy(EPP) and pleurectomy / decortication(P/D) which aim to achieve macroscopic complete resection(MCR) in the treatment of MPM. Finally, we summarized the progress of other treatment methods including targeted therapy and immunotherapy.

Treatment of stage Ⅲ NSCLC is challenging, and the best treatment strategy is still controversial. The emergence of new therapeutic agents and philosophy also continues to redefine the range of resectable/ potentially resectable NSCLC. Resectable N2-stage Ⅲ lymph nodes are usually scattered with well-defined margins and no adhesions to surrounding structures. Neoadjuvant therapy followed by surgery has lower local recurrence rate compared to radical radiotherapy. According to current guidelines, surgical treatment is not recommended for N3-stage Ⅲ NSCLC. However, for regional N3 disease with continuous response to chemotherapy, after careful selection, surgery may worth a try. The efficacy of immunotherapy in locally advanced lung cancer has been confirmed in many prospective clinical trials. Neoadjuvant immunotherapy significantly improves major pathological remission rates and pathological complete remission rates, which allows these downstaging patients have the chance to receive surgery and thus improve their long-term prognosis. For efficacy assessment of neoadjuvant immunotherapy, pathological biopsy is more reliable than CT. In conclusion, the progress in multimodality neoadjuvant therapy will provide more surgical opportunities and better long-term prognosis for patients with potentially resectable stage Ⅲ NSCLC.

Objective     To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. Methods    The clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. Results    A total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P<0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P>0.05). Conclusion    The learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.