Surgical treatment is one of the key approaches for non-small cell lung cancer (NSCLC). Regular postoperative follow-up is crucial for early detection and timely management of tumor recurrence, metastasis, or second primary tumors. A scientifically sound and reasonable follow-up strategy not only extends patient survival but also significantly improves quality of life, thereby enhancing overall prognosis. This consensus aims to build upon the previous version by incorporating the latest clinical research advancements and refining postoperative follow-up protocols for early-stage NSCLC patients based on different treatment modalities. It provides a scientific and practical reference for clinicians involved in the postoperative follow-up management of NSCLC. By optimizing follow-up strategies, this consensus seeks to promote the standardization and normalization of lung cancer diagnosis and treatment in China, helping more patients receive high-quality care and long-term management. Additionally, the release of this consensus is expected to provide insights for related research and clinical practice both domestically and internationally, driving continuous development and innovation in the field of postoperative management for NSCLC.

With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

Resection is one of the most important treatments for esophageal squamous cell carcinoma, and routine postoperative follow-up is an effective method for early detection and treatment of recurrent metastases, which can improve patients' quality of life and prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of esophageal squamous cell carcinoma patients in China, and further improve the standardization of the diagnosis and treatment of esophageal squamous cell carcinoma.

Resection is crucial for treating non-small cell lung cancer. Routine follow-up after surgery is an effective method for early detection and treatment of tumor recurrence and metastasis or the second primary tumor, which can improve the quality of life of patients and their prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of non-small cell lung cancer patients in China, and further improve the standardization of lung cancer diagnosis and treatment.

Objective: To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10). Methods: Between March 2018 to September 2018, 14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10). Results: Of the 14 patients, including 5 males and 9 females, age (52.2±5.3)years, size (1.1±0.6)cm, 6 left S10 and 8 right S10. The number of pathological type of microinvasive adenocarcinoma, benign nodule, and metastatic carcinoma was 12, 1, and 1 cases. The average preoperative planning time was (44.9±5.7)min, and the average operation time was (134.8±26.3)min. The blood loss was (25.5±4.1)ml, with (8.1±2.7) lymphadenectomy, no positive metastasis. The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location, B10, A10, and V10 were 100%(14/14), 100%(14/14), 93%(13/14) and 71%(10/14). The median duration of chest tube insertion was (2.3±2.1)day. The incidence of postoperative complications was 21%(3/14), including 7%(1/14) of air leakage, 7%(1/14) of arrhythmia, 14%(2/14) of pulmonary infection, and 14%(2/14) of operation. All the cutting edge was >2 cm. There was no perioperative death, no conversion to thoracotomy or lobectomy. The mean follow-up time was (8.1±2.2)months. There were no recurrence, metastasis or death in the 14 patients. One patient had chronic cough and no hemoptysis. Conclusions Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective.

OBJECTIVETo explore the application of mesoesophagus suspension technique to improve the upper mediastinal lymph node dissection during thoracoscopic esophagectomy in the treatment of esophageal cancer.

METHODSClinical data of 164 thoracic esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy with two-field lymph node dissection in the Union Hospital of Fujian Medical University between October 2012 and June 2015 were retrospectively analyzed. Among 164 patients, 80 cases underwent upper mediastinal lymph node dissection by traditional method (traditional group), and the remaining 84 cases underwent upper mediastinal lymph node dissection by mesoesophagus suspension technique (suspension group). The operation time, estimated blood loss, number of excised lymph nodes and postoperative complications were compared between the two groups.

RESULTSThere were no significant differences in gender, age, location of tumor and pathology stage between the two groups. The operation time in the two groups was similar. The suspension group had significantly less thoracic blood loss than traditional group [(85±5) ml vs.(140±7) ml, P=0.000]. The number of dissected lymph nodes of bilateral recurrent laryngeal nerve was more in suspension group [median (interquartile range): left: 3 (2 to 4) vs. 2 (1 to 3), P=0.013; right: 3(2 to 6) vs. 2(1 to 3), P=0.007]. There was no significant difference in metastatic rate of lymph node in different sites between the two groups. The highest metastatic rate of suspension and traditional group was found at paracardia lymph nodes[22.6%(19/84) and 22.5%(18/80)], the next was at right laryngeal nerve lymph nodes [17.9%(15/84) and 15.0%(12/80)] and left laryngeal nerve lymph nodes [16.7%(14/84) and 12.5%(10/80)]. There were no significant differences with regard to the incidence of major postoperative complications between two groups, including respiratory complication, anastomotic leakage, vocal cord palsy.

CONCLUSIONSUpper mediastinal bilateral recurrent laryngeal nerve lymph node is the predilection site of lymphatic metastasis of thoracic esophageal cancer. Application of mesoesophagus suspension technique in thoracoscopic esophagectomy can improve the clearance quality of bilateral recurrent laryngeal nerve lymph nodes.

Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; adverse effects ; methods ; Lymph Nodes ; anatomy & histology ; pathology ; surgery ; Lymphatic Metastasis ; physiopathology ; Male ; Mediastinum ; surgery ; Operative Time ; Postoperative Complications ; Recurrent Laryngeal Nerve ; physiopathology ; Retrospective Studies ; Treatment Outcome

Objective: To explore the security and the radical and clinical value of thoracoscopic-laparoscopic esophagectomy with two-field lymph node dissection for middle esophageal cancer through comparison with open esophagectomy. Methods: A total of 410 stage II to stage III esophageal cancer patients who underwent two-field lymph node dissection with two different methods (thora-colaparoscopic esophagectomy and open esophagectomy) from January 2009 to July 2013 in Uninon Hospital, Fujian Medical Universi-ty, were analyzed retrospectively. General pathological parameters, operative procedures, and short-term outcomes were collected and compared between the two groups (TLG and OG). Results: No significant differences were found regarding general pathological pa-rameters, such as gender, age, etc. Significant differences between thoracolaparoscopic and open two-field lymph node dissection esoph-agectomy were observed in terms of esophagectomy intraoperative blood loss [(206 ± 138) mL vs. (240±111) mL] and the mean num-ber of dissected lymph node per person [(26.6±8.6)/per vs. (21.7±9.2)/per]. Overall postoperative morbidity rate in OG was 35.2%, and its difference from that of TEG (25.8%) is statistically significant (P<0.05). Regarding single complications, such as pulmonary infec-tion and arrhythmia, OG showed evidently superior results (P<0.05). Meanwhile, anastomotic stricture and hoarseness rate are higher in TEG (P<0.05), and the difference was statistically significant as well. Conclusion: Thoracolaparoscopic two-field esophagectomy is technically feasible and safe and can achieve radical tumor resection.

OBJECTIVETo compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer.

METHODSRetrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients, 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil(Orvil)(Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis(McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups.

RESULTSThere were no statistical differences between two groups in intra-operative blood loss, conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group [(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492±18 553) yuan vs. (68 923±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group(16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication(8.7% vs. 25.9%, P<0.01), anastomotic leakage(1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury(1.0% vs. 7.0%, P<0.05).

CONCLUSIONIvor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.

Anastomosis, Surgical ; Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies

Objective To compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer. Methods Retrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients , 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil (Orvil) (Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis (McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups. Results There were no statistical differences between two groups in intra-operative blood loss , conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group[(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492 ±18 553) yuan vs. (68 923 ±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group (16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication (8.7% vs. 25.9%, P<0.01), anastomotic leakage (1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury (1.0% vs. 7.0%, P<0.05). Conclusion Ivor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.

Objective To compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer. Methods Retrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients , 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil (Orvil) (Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis (McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups. Results There were no statistical differences between two groups in intra-operative blood loss , conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group[(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492 ±18 553) yuan vs. (68 923 ±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group (16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication (8.7% vs. 25.9%, P<0.01), anastomotic leakage (1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury (1.0% vs. 7.0%, P<0.05). Conclusion Ivor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.