Salvage surgery is an emerging option for carefully selected patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) whose disease remains controlled on tyrosine kinase inhibitor (TKI) therapy. Fourteen retrospective series report median progression-free survival (PFS) of 14–52 months and overall survival (OS) often exceeding 3 years, suggesting better disease control than continued TKI therapy alone. Although PFS generally improves, some cohorts show no OS advantage, probably because effective post-progression treatments dilute survival differences. Non-surgical local consolidative therapies remain essential for oligometastatic disease; nevertheless, resection yields intact specimens for comprehensive pathologic and molecular analysis.Access to tissue permits earlier identification of resistance mechanisms—most commonly the T790M mutation—more accurate prognostication, and more precise systemic-therapy selection. Comprehensive sampling can also identify histologic transformation and compound mutations that precede radiologic progression. Adverse prognostic factors include older age, high preoperative carcinoembryonic antigen levels, advanced pathological T stage, programmed death-ligand 1 ≥1%, and spread through air spaces. Salvage surgery is feasible and effective in carefully selected patients, especially those with oligoresidual disease and favorable tumor biology. Patient selection should integrate performance status, anatomic extent, histopathology, and genomic profile through multidisciplinary discussions. Despite regional differences (e.g., higher EGFR-mutation prevalence and wider adoption of minimally invasive approaches in East Asia) oncologic outcomes are comparable when selection criteria are applied consistently. Prospective trials are warranted to validate these retrospective observations, refine selection algorithms, establish optimal timing, and clarify how surgery can best be integrated with next-generation targeted agents and immunotherapies.

Coronary artery bypass grafting (CABG) remains a key revascularization strategy for ischemic heart disease; however, nationwide trends in the Republic of Korea have not been thoroughly investigated. Using data from the Korean National Health Insurance Service, we analyzed adult patients who underwent isolated CABG between 2005 and 2022. We evaluated surgical volume, patient demographics, procedural strategies (off-pump vs. onpump), and outcomes. International comparisons were conducted using national cardiac surgery registry data. A total of 51,923 CABG cases were identified. Annual surgical volume declined until 2013 but gradually increased thereafter, reaching 3,717 cases in 2022. Despite this recovery, Korea’s per capita CABG rate remains among the lowest worldwide.In contrast, more than 60% of procedures were performed off-pump—the highest rate worldwide. Over time, the average patient age and prevalence of diabetes increased, whereas in-hospital mortality showed a modest decline. Compared with other countries, the Republic of Korea demonstrated a uniquely low procedural volume and a strong preference for off-pump CABG. This nationwide analysis highlights Korea’s distinctive CABG practice patterns and provides valuable insights for optimizing future clinical and policy decisions in cardiac surgical care.

Foreign body aspiration is frequently encountered in children but can also occur in adults, where it often remains undiagnosed for years. Forgotten foreign bodies within the bronchial tree may later manifest with either vague symptoms or life-threatening complications, such as massive hemoptysis. Contrast-enhanced computed tomography of the thorax is the preferred initial diagnostic modality and can suggest the presence of a foreign body. We present a case involving an adult who remained undiagnosed until adulthood, when he was ultimately found to have a foreign body embedded in the lung parenchyma.

Background: Pleural drainage is essential for preventing and managing respiratory complications after video-assisted thoracoscopic esophagectomy (VATE). Conventional largebore drains often cause significant pain. Small-bore drains (e.g., 19F Blake drains) may reduce discomfort; however, evidence regarding their use in VATE is limited. This study compared drainage effectiveness and pain between 19F Blake drains and conventional 28F drains after VATE for esophageal cancer. Methods: This retrospective study included 77 male patients with middle- or lower-third esophageal cancer who underwent VATE with laparoscopic retrosternal tunneling from November 2018 to November 2022. Fifty-five patients received a 28F conventional drain, and 22 received a 19F Blake drain. Outcomes included drainage duration and volume, pain levels (Visual Analog Scale [VAS]), postoperative pneumonia rates, and pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) on postoperative day 3. Results: The 19F group reported significantly lower pain scores on postoperative days 1–3 (VAS: 2.95–3.25 vs. 4.07–4.62, p<0.001). Drainage duration and pneumonia rates were similar between groups. The 19F group demonstrated a trend toward higher drainage volume and significantly better preservation of pulmonary function, with smaller declines in FVC (ΔFVC: 0.24±0.20 L vs. 0.63±0.17 L, p<0.001) and FEV1 (ΔFEV1: 0.38±0.25 L vs. 0.58±0.25 L, p=0.02). Conclusion 19F Blake drains provide similar drainage effectiveness to that of 28F drains, with reduced postoperative pain and better pulmonary function preservation. These findings support the use of 19F Blake drains to improve patient comfort and recovery following VATE.

Coronary artery bypass grafting (CABG) has been established as the most effective treatment for patients with multi-vessel coronary artery disease. To maximize outcomes by restoring perfusion to the largest possible myocardial territory, complete revascularization (CR) has long been a key objective of CABG. Because the anatomic severity of coronary artery stenosis on coronary angiography has been the main criterion for selecting target vessels for several decades, the definition of CR has traditionally been based on angiographic anatomy. Numerous studies have examined the impact of anatomic CR on outcomes after CABG; however, the results remain controversial. At the same time, there has been increasing interest in ischemia-inducing coronary artery stenosis assessed by functional studies such as dobutamine-stress echocardiography, nuclear imaging tests, fractional flow reserve, and quantitative flow ratio. This has raised the importance of defining CR based on functional ischemia rather than anatomic stenosis. Nevertheless, only a few studies have reported the impact of functional CR on CABG outcomes. Therefore, this narrative review summarizes the various definitions of CR in CABG, highlights its benefits and shortcomings, and introduces the available literature evaluating the effects of anatomic and functional CR on long-term clinical outcomes.

Background: The optimal treatment for primary spontaneous pneumothorax (PSP) remains undefined. Furthermore, the overall utilization and costs of various treatment approaches are incompletely understood. We investigated hospital charges and resource utilization by management strategy across the state of Maryland in adult and pediatric patients with PSP. Methods: We queried the Maryland Health Services Cost Review Commission database for patients aged 10–40 years admitted with PSP between 2012 and 2020. Patients managed with a chest tube alone (CT) were compared with recipients of video-assisted thoracoscopic surgery (VATS). Subsequently, we analyzed hospital charges for patients undergoing early VATS (<48 hours post-admission) vs. delayed VATS (≥48 hours). The predicted incremental cost of early vs. delayed VATS was calculated. Results: Overall, 354 admissions were identified, with 211 (59.6%) receiving CT management and 143 (40.4%) undergoing VATS. Patients receiving VATS were more likely to be female (24% vs. 15%, p=0.030) and Black (32% vs. 20%, p=0.035) than CT recipients.The median total hospital charge for CT recipients was $6,493, compared to $20,437 for patients managed surgically (p<0.001). Delayed surgery during the index admission was associated with significantly higher total hospital charges—including operating room, room and board, radiology, and laboratory costs—than early surgery. Applying early VATS to all patients appeared more cost-efficient than delayed VATS (per-patient costs: $18,568 vs. $30,832, p<0.001), although the former had slightly higher recurrence (7.9% vs. 1.5%, p=0.08). Conclusion Variations in management strategies, particularly surgical decision-making and timing, impact hospital charges and utilization for patients with PSP.