Elderly patients with lung cancer have a significantly increased risk of perioperative cardiopulmonary complications due to physiological decline, high incidence of complications and reduced surgical tolerance, which directly affects postoperative recovery and long-term survival. Although the concepts of minimally invasive surgery and enhanced recovery after surgery have improved clinical outcomes, early recognition and intervention of postoperative complications in elderly patients remains a significant challenge in the field of thoracic surgery. By integrating recent literature and clinical practice, this paper systematically analyzes the pathophysiological mechanism and risk factors of perioperative cardiopulmonary complications in elderly patients with lung cancer, and discusses individualized intervention strategies based on risk stratification and multidisciplinary team, in order to provide theoretical basis and practical guidance for optimizing perioperative management and improving postoperative prognosis in elderly patients.

Objective To investigate the independent risk factors for hypertrophic cardiomyopathy(HCM)with atrial fibrillation(AF)based on cardiac magnetic resonance(CMR)using logistic regression analysis.Methods We reviewed 80 patients diagnosed with HCM at our hospital between January 2022 and December 2023.Statistical differences in the CMR and clinical parameters between patients with HCM with and without AF were compared.The cut-off value of HCM with AF was obtained by receiver operator characteristic curve,and binary logistic regression analysis was performed on statistically significant variables to identify independent risk factors for HCM in patients with AF.Results Univariate analysis showed that there were significant differences in the type of left ventricular late gadolinium enhancement(LGE),native T1 mapping value of the left ventricular myocardium without LGE,left atrial anteroposterior diameter,number of left ventricular LGE myocardial segments,and LGE in the basal anterior interventricular septum,mid anterior interventricular septum,and mid inferior interventricular septum were between HCM with and without AF(P＜0.05).Multivariate analysis revealed that there were significant differences in left ventricular subendocardial LGE(P=0.048,OR=5.3,95％CI:0.642-43.311),native T1 mapping value of left ventricular myocardium without LGE≥1 247 ms(P=0.03,OR=5.7,95％CI:0.734-27.41),and left atrium anteroposterior diameter 50 mm(P=0.013,OR=6.9,95％CI:1.489-31.538)between HCM with and without AF.Conclusion Left ventricular subendocardial LGE,native T1 mapping value≥1 247 ms,and left atrium anteroposterior diameter≥50 mm are independent risk factors for HCM with AF.

Objective:To evaluate the impact of the surgical strategy of selective thoracic duct(TD) ligation established through fluorescence thoracoscopy TD imaging technology on the occurrence of chylothorax after lung cancer surgery in the elderly.Methods:A prospective cohort study was conducted.Elderly patients who underwent right lung cancer surgery in the Department of Thoracic Surgery of Beijing Hospital from October 2023 to June 2024 were enrolled as the research subjects.The surgical approaches involved pulmonary resection, systematic lymphadenectomy, and selective TD ligation using fluorescence thoracoscopy.Prior to the surgery, 0.4 mg/kg indocyanine green(ICG)was injected subcutaneously into the right inguinal region of all patients.Clinical data, surgical details, pathological information, and intraoperative TD imaging, including the course, collateral vessels, and any injuries, were collected.Postoperative chylothorax and other complications were also recorded.Results:A total of 83 patients were enrolled, of which 38 were males, and 45 were females, with a median age of 68 years raging from 60 to 83 years old, TD imaging was observed in 69 cases(83.1%)within one hour after IGC injection.Intraoperative injuries of collateral branches were visualized in 4 cases(4.8%). Among them, 2 cases had injuries in both the 2R+ 4R and the subcarinal station, while 2 others had injuries of collateral branches only in the 2R+ 4R station.These 4 patients underwent concurrent TD ligation.No TD or collateral injury was found in the remaining patients during the surgery, and the TD was not ligated, none of the patients developed chylothorax postoperatively, and no adverse reactions related to indocyanine green were observed.Conclusions:Fluorescence thoracoscopy-guided TD imaging technique can well visualize TD and its collateral injuries in elderly lung cancer surgeries, assist in the management of leaks or TD ligation, thereby effectively preventing the occurrence of postoperative chylothorax.

Objective:To evaluate the impact of the surgical strategy of selective thoracic duct(TD) ligation established through fluorescence thoracoscopy TD imaging technology on the occurrence of chylothorax after lung cancer surgery in the elderly.Methods:A prospective cohort study was conducted.Elderly patients who underwent right lung cancer surgery in the Department of Thoracic Surgery of Beijing Hospital from October 2023 to June 2024 were enrolled as the research subjects.The surgical approaches involved pulmonary resection, systematic lymphadenectomy, and selective TD ligation using fluorescence thoracoscopy.Prior to the surgery, 0.4 mg/kg indocyanine green(ICG)was injected subcutaneously into the right inguinal region of all patients.Clinical data, surgical details, pathological information, and intraoperative TD imaging, including the course, collateral vessels, and any injuries, were collected.Postoperative chylothorax and other complications were also recorded.Results:A total of 83 patients were enrolled, of which 38 were males, and 45 were females, with a median age of 68 years raging from 60 to 83 years old, TD imaging was observed in 69 cases(83.1%)within one hour after IGC injection.Intraoperative injuries of collateral branches were visualized in 4 cases(4.8%). Among them, 2 cases had injuries in both the 2R+ 4R and the subcarinal station, while 2 others had injuries of collateral branches only in the 2R+ 4R station.These 4 patients underwent concurrent TD ligation.No TD or collateral injury was found in the remaining patients during the surgery, and the TD was not ligated, none of the patients developed chylothorax postoperatively, and no adverse reactions related to indocyanine green were observed.Conclusions:Fluorescence thoracoscopy-guided TD imaging technique can well visualize TD and its collateral injuries in elderly lung cancer surgeries, assist in the management of leaks or TD ligation, thereby effectively preventing the occurrence of postoperative chylothorax.

Objective To investigate the independent risk factors for hypertrophic cardiomyopathy(HCM)with atrial fibrillation(AF)based on cardiac magnetic resonance(CMR)using logistic regression analysis.Methods We reviewed 80 patients diagnosed with HCM at our hospital between January 2022 and December 2023.Statistical differences in the CMR and clinical parameters between patients with HCM with and without AF were compared.The cut-off value of HCM with AF was obtained by receiver operator characteristic curve,and binary logistic regression analysis was performed on statistically significant variables to identify independent risk factors for HCM in patients with AF.Results Univariate analysis showed that there were significant differences in the type of left ventricular late gadolinium enhancement(LGE),native T1 mapping value of the left ventricular myocardium without LGE,left atrial anteroposterior diameter,number of left ventricular LGE myocardial segments,and LGE in the basal anterior interventricular septum,mid anterior interventricular septum,and mid inferior interventricular septum were between HCM with and without AF(P＜0.05).Multivariate analysis revealed that there were significant differences in left ventricular subendocardial LGE(P=0.048,OR=5.3,95％CI:0.642-43.311),native T1 mapping value of left ventricular myocardium without LGE≥1 247 ms(P=0.03,OR=5.7,95％CI:0.734-27.41),and left atrium anteroposterior diameter 50 mm(P=0.013,OR=6.9,95％CI:1.489-31.538)between HCM with and without AF.Conclusion Left ventricular subendocardial LGE,native T1 mapping value≥1 247 ms,and left atrium anteroposterior diameter≥50 mm are independent risk factors for HCM with AF.

Objective:To evaluate the safety of thymic surgery in patients aged 65 years and over.Methods:A total of 696 patients who underwent thymectomy/thymoma resection in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were collected and divided into two groups according to the age of 65 years old.The preoperative course of disease, MG stage, dosage of pyridostigmine bromide, American College of Anesthesiologists(ASA)score, surgical method, intraoperative bleeding, postoperative drainage, postoperative complications, Clavien-dindo score(CDC), and myasthenic crisis were recorded and statistically analyzed.Results:A total of 696 patients were enrolled, including 364 males and 332 females, aged 15~86 years, with an average age of 49.1 years.There were 309 patients with thymoma, 565 patients with MG, and 178 patients with both.There were 124 cases in the elderly group(≥65 years old)and 572 cases in the non-elderly group(<65 years old). The incidence of thymoma was higher in the elderly group(54.8 % versus 42.1 %, χ2=6.664, P=0.010), while the incidence of MG was lower(67.7 % versus 84.1 %, χ2=17.827, P<0.001). The ASA score of the elderly group was higher than that of the non-elderly group( χ2=52.372, P=0.000), and the preoperative ventilation function FEV1 and FEV1/FVC were also significantly lower than those of the non-elderly group( z=8.187, 4.580, P=0.000 for all). The drainage volume in the first 3 days after operation and postoperative drainage tube time in the elderly group were significantly higher than those in the non-elderly group( P=0.018, P=0.003). The incidence of postoperative myasthenia crisis in the elderly group was higher than that in the non-elderly group( P=0.034). There was no significant difference in the incidence of postoperative complications between the two groups, but after Clavien-dindo classification, the score of the elderly group was higher than that of the non-elderly group( P=0.003). Although the ASA score and Clavien-dindo score of the elderly group were both higher than those of the non-elderly group, there was no correlation between the two. Conclusions:Although the preoperative ASA score and pulmonary function of elderly patients were poorer than those in the non-elderly group, while the incidence of postoperative myasthenia crisis was higher, and the incidence of postoperative complications was not higher, the Clavien-dindo classification, however, was higher in elderly patients than that of the non-elderly group.After careful preoperative evaluation and strengthening perioperative management, most elderly patients can receive thymus surgery safely with acceptable risks.