Chronic post-surgical pain (CPSP) is a common long-term complication following lung surgery. Its high incidence significantly impacts patients’ quality of life and functional recovery, and imposes a substantial socioeconomic burden. This consensus aims to systematically establish a standardized integrated Chinese and Western medicine diagnostic and treatment framework for chronic post-lung surgery pain (CPLSP). Based on the latest domestic and international evidence-based medical research and multidisciplinary clinical experience, the working group comprehensively elaborates on core issues regarding CPLSP, including its definition, epidemiology, pathogenesis, clinical assessment, Western medical treatment, traditional Chinese medicine (TCM) treatment, and integrated strategies. The consensus emphasizes a patient-centered approach, adhering to the principles of multimodality, individualization, and stepwise management, highlighting the synergistic advantages of integrating Chinese and Western medicine throughout the entire perioperative management cycle encompassing "perioperative anti-inflammation, acute analgesia, and chronic rehabilitation." Through systematic literature retrieval and evidence integration, a total of 9 core recommendations were established to provide scientifically sound and clinically practical guidance.

BACKGROUND: Lung cancer has the highest mortality rate among all malignant tumors, and non-small cell lung cancer (NSCLC) accounts for about 80%-85% of all lung cancers. Lobectomy and lymph node dissection are one of the most important treatment methods, and lymph node dissection, as an important part, has attracted much attention. And its mode and scope of dissection may affect postoperative complications, particularly the occurrence of chronic cough. The aim of this study is to investigate the effect of lymph node dissection on postoperative chronic cough in patients with NSCLC undergoing lobectomy, and to provide clinical evidence for optimizing surgical strategy and reducing postoperative chronic cough. METHODS: A retrospective analysis was conducted on the clinical data of 365 NSCLC patients who underwent lobectomy at the First Affiliated Hospital of University of Science and Technology of China from December 2020 to December 2023. The relationship between clinical characteristics and postoperative chronic cough was analyzed. The Chinese version of the Leicester Cough Questionnaire (LCQ-MC) scores were collected from the patients at 2 time points: 1 day before surgery and 8 weeks after surgery. Patients were divided according to lymph node dissection methods, to explore the relationship between lymph node dissection and chronic cough after lobectomy. Additionally, patients were divided into chronic cough and non-chronic cough groups based on the presence of postoperative chronic cough, to investigate whether perioperative data, lymph node dissection methods, and lymph node dissection regions were influencing factors. RESULTS: Patients undergoing lobectomy were more likely to have chronic cough after surgery in the systematic lymph node dissection group than in the lymph node sampling group (P<0.05). LCQ-MC scale evaluation showed that the psychological, physiological, social and total score of the patients in systematic lymph node dissection group were significantly lower than those in lymph node sampling group (P<0.05). Multivariate analysis showed that anesthesia time, operation site, lymph node dissection method, whether to perform upper mediastinal lymph node dissection, number of upper mediastinal lymph node dissection, whether to perform lower mediastinal lymph node dissection and total number of lymph node dissection were independent risk factors for postoperative chronic cough in NSCLC patients (P<0.05). CONCLUSIONS When NSCLC patients underwent lobectomy, lymph node sampling was associated with a significantly lower risk of chronic cough than systematic lymph node dissection. Dissecting lymph nodes in the upper and lower mediastinal regions and the number of lymph nodes dissected may increase the risk of postoperative cough and reduce the quality of life of patients after surgery.
Humans ; Carcinoma, Non-Small-Cell Lung/surgery* ; Male ; Female ; Lung Neoplasms/surgery* ; Middle Aged ; Cough/etiology* ; Retrospective Studies ; Lymph Node Excision/methods* ; Aged ; Chronic Disease ; Postoperative Complications/etiology* ; Adult ; Lymph Nodes/surgery* ; Pneumonectomy/adverse effects* ; Chronic Cough

Objective:To investigate the feasibility, safety, and short-term efficacy of the application of near-infrared fluorescence imaging of tharacic duct(NFITD) by indocyanine green(ICG) in minimally invasive McKeown esophagectomy(MIME).Methods:The clinical data of the patients underwent MIME for esophageal cancer in the First Affiliated Hospital of University of Science and Technology of China From January 2024 to April 2024 were restrospectively analyzed. There were divided into a indocyanine green imaging of thoracic duct(ITD) group and a non indocyanine green imaging of thoracic duct(NITD) group according to intraoperative visualization of morphological patterns of the thoracic duct. The clinicopathologic factors, preoperative adjuvant therapy, surgery-related indicators, postoperative complications were compared between the two groups.Results:In the comparison of general data between the two groups of patients, there were differences in preoperative neoadjuvant therapy between the ITD group and the NITD group. However, there were no significant differences between the two groups in terms of age, gender, tumor segmentation, degree of differentiation, smoking history, drinking history, and preoperative comorbidities. In the perioperative data, the ITD group had advantages in total pleural effusion volume on the third day after surgery, total hospitalization cost, and intraoperative discovery of thoracic duct injury( P<0.05). In terms of the number of metastatic lymph nodes, the ITD group was higher than the NITD group( P<0.05). There were no significant differences between the two groups in terms of operation time, postoperative hospital stay, total pleural effusion volume on the 1st and 2nd days after operation, whether the thoracic duct was ligated, whether there was thoracic adhesion, pTNM stage, the number of lymph node dissection stations and the number of lymph node dissections. In terms of the minor complications of chylothorax after surgery, the ITD group was significantly less than the NITD group. There was no significant difference in other complications between the two groups of patients. Conclusion:NFITD combined with MIME can be safety and effectively performed for patients with esophageal cancer with significant advantages in reducing postoperative chylothorax.

Objective To analyze the risk factors for chronic cough following pulmonary surgery in patients with non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on 427 NSCLC patients who underwent pulmonary surgery in the Department of Thoracic Surgery, The First Affiliated Hospital of the University of Science and Technology of China, between January 2021 and June 2023. Patients were categorized into a chronic cough group (103 patients) and a non-chronic cough group (324 patients) based on the presence of cough at 8 weeks post-surgery. A comparative analysis was performed between the two groups, considering gender, age, smoking history, comorbidities, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration. Factors showing statistical significance in univariate analysis underwent multivariate logistic regression analysis. Results Among the 427 patients undergoing pulmonary surgery, there were 165 males and 262 females, with an average age of (59.93±12.11) years. The incidence of chronic cough was 24.12%. Univariate analysis revealed significant differences in smoking history, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration ≥135.5 minutes, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration (P<0.05). Multivariate logistic regression analysis indicated that the surgical site (right upper lung), operative techniques (lobectomy), lymph node dissection, and anesthesia time ≥135.5 minutes were independent risk factors for chronic cough following pulmonary surgery. Conclusion Patients undergoing right upper lung surgery, lobectomy, lymph node dissection, and experiencing anesthesia duration ≥135.5 minutes are at a higher risk of developing chronic cough post-pulmonary surgery.

Objective:To explore the operioperative and long-term outcomes of inflatable mediastinoscopic resection of esophageal carcinoma (IVMTE) and minimally invasive Mckeown resection of esophageal carcinoma (MIME) in early esophageal cancer.Methods:This is a retrospective cohort study. A retrospectively analysis was conducted on 176 patients with cT1N0M0 esophageal cancer who underwent IVMTE or MIME at the Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from April 2017 to April 2019. There were 128 males and 48 females, aged (66.4±7.7) years (range: 45 to 87 years). General data, perioperative outcomes, pathological data of the tumors, and complications were recorded. Independent sample t-test, χ2 test, or Wilcoxon rank-sum test was used to compare the data between the two groups. Propensity score matching was performed with gender, age, tumor location, differentiation degree, pT stage, pN stage, American Society of Anesthesiologists (ASA) classification, smoking history, and alcohol history were considered as covariates. The IVMTE group and MIME group were matched in a 1∶2 ratio using nearest neighbor match method with a caliper value of 0.02. Kaplan-Meier method was used to plot survival curves, with Log-rank test for univariate survival analysis. The Cox proportional hazards model was applied to analyze prognostic factors for overall survival, and subgroup stratification analysis was performed for pT stage. Results:After matching, the MIME group consisted of 54 cases, and the IVMTE group consisted of 27 cases. There were no statistically significant differences between the two groups in terms of gender, age, smoking history, alcohol history, ASA classification, tumor location, and other factors. The IVMTE group had shorter surgery time ( M(IQR), 220 (45) minutes vs. 245 (56) minutes, Z=2.950, P=0.003) and less intraoperative blood loss (100 (50) ml vs. 125 (100) ml, Z=2.193, P=0.028) compared to the MIME group. There were no differences between the two groups in the number and quantity of lymph node stations dissected, and the IVMTE group was not at a disadvantage in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (all P>0.05). The 1-, 3-, and 5-year overall survival (OS) rates and recurrence-free survival (RFS) rates were not significantly different between the two groups (all P>0.05). Subgroup analysis showed no significant difference in OS and RFS rates between the pT1 and pT2 subgroups (all P>0.05). Multivariate Cox regression analysis suggested that ASA classification ( HR=2.516, 95% CI: 1.126 to 5.624, P=0.025), pN stage ( HR=2.485, 95% CI: 0.984 to 6.274, P=0.046), and whether adjuvant therapy was given postoperatively ( HR=2.915, 95% CI: 1.304 to 6.515, P=0.009) were independent risk factors affecting 5-year OS rate. For 5-year RFS, pT stage ( HR=0.403, 95% CI: 0.194 to 0.838, P=0.011), pN stage ( HR=5.219, 95% CI: 2.401 to 11.346, P<0.01), and whether adjuvant therapy was given postoperatively ( HR=5.644, 95% CI: 2.691 to 11.838, P<0.01) were independent risk factors, while the surgical approach was not an independent risk factor affecting patient prognosis. Conclusion:The short-term and long-term effect of IVMTE in the treatment of early esophageal cancer is good, and it can achieve effects comparable to MIME.

Objective To compare the short-term outcomes of single-port video-assisted thoracoscopic(VATS)pulmonary surgery using a chest-wall-muscle-sparing incision versus a standard incision.Methods A total of 215 patients undergoing single-port video-assisted thoracoscopic lung surgery in the Department of Cardiothoracic Surgery,The First Hospital of Anhui University of Science&Technology from February 2024 to May 2025 were recruited in this clinical observation.Clinical data were retrospectively analyzed.The patients were divided into a chest wall muscle sparing incision group and a chest wall standard incision group.Short-term prognoses of the two groups were compared.Results A total of 180 patients was included:80 in the chest wall muscle sparing incision group and 100 in the chest wall standard incision group.The two groups had similar baseline characteristics,includ-ing body-mass index(23.86±3.70 vs.23.45±3.20 kg/m2;P>0.05).All procedures were completed successfully without perioperative mortality,conversion to thoracotomy,or extension of the incision.The standard incision group had 4 latissimus dorsi injuries and 5 patients with shoulder joint dysfunction on the 30th day after discharge,charac-terized by chest wall muscle tightness accompanied by chest pain and limited upper limb mobility(P<0.05).Although skin-to-skin incision time was slightly longer in the muscle-sparing group(P=0.06),pain scores at every assessed time point were significantly lower(P<0.05),and no patient developed shoulder dysfunction.No significant differences were observed in incisional fat-liquefaction rate,incision length,operative time,blood loss,or chest-tube duration(P>0.05).Conclusion The chest wall muscle sparing incision in single-port video-assisted thoracoscopic lung surgery not only preserves the latissimus dorsi and serratus anterior muscles,significantly reduces postoperative incision pain,and minimizes chest wall muscles and shoulder dysfunction,exhibiting clear minimally invasive advantages in single-port VATS lung surgery.

OBJECTIVE To investigate the application of metagenomic next-generation sequencing(mNGS)of bron-choalveolar lavage fluid(BALF)in the detection of pathogens of pulmonary infection.METHODS The clinical data of 98 patients with pulmonary infections admitted to NO.2 People's Hospital of Fuyang City from Jan.2023 to Jan.2024 were retrospectively analyzed,mNGS and traditional pathogenicity test were performed in BALF,and comprehensive clinical judgment(using a combination of alveolar lavage fluid,sputum,blood,etc.to assess)was used as the gold standard to evaluate the differences between mNGS and traditional pathogenicity tests in the path-ogenic diagnosis of pulmonary infections,compare the pathogen detection rates in pulmonary infections complicat-ed with underlying diseases,severe and non-severe illness and different infection types,and to analyze the impact on clinical adjustment of anti-infection regimens.RESULTS The positive detection rate of mNGS for pulmonary in-fection pathogens was 88.78％,higher than that of traditional pathogenology(P＜0.001).The time required for mNGS was(16.57±2.64)h,shorter than that of traditional pathogenology(P＜0.05).The positive detection rates of mNGS in patients with and without underlying diseases were 93.02％and 85.45％,respectively,higher than those of traditional pathogenology(P＜0.05).The positive detection rates of mNGS in severe and non-severe patients were 91.43％and 87.30％,respectively,higher than those of traditional pathogenology(P＜0.05).A total of 122 strains of pathogens were detected in 87 patients with positive mNGS tests,and EB virus was not de-tected.A total of 75 strains of pathogens were detected in 54 patients with positive traditional pathogenetic tests,and Neisseria,Rhizopus,parvovirus,and Chlamydia psittaci were not detected.The detection rate of bacteria by mNGS was 58.20％,higher than that by traditional pathogenetic tests(P=0.034).The detection rates of mNGS test for monotypic infection and mixed infection were 85.51％and 93.10％,respectively,higher than those by traditional pathogenetic test(P＜0.05).In pulmonary infections,mNGS guided adjustment of anti-infective treat-ment in 53.06％of patients,60.47％of those in the group with underlying pulmonary disease,and 47.27％of those without underlying disease(P=0.194).Among severe cases,68.57％had their anti-infective treatment plan adjusted,compared to 44.44％of non-severe patients(P=0.022).CONCLUSION The mNGS of BALF idenfies some rare pathogens,improves the detection rate of pathogens in pulmonary infections,and may guide the clinical adjustment of anti-infective strategies.

OBJECTIVE To investigate the application of metagenomic next-generation sequencing(mNGS)of bron-choalveolar lavage fluid(BALF)in the detection of pathogens of pulmonary infection.METHODS The clinical data of 98 patients with pulmonary infections admitted to NO.2 People's Hospital of Fuyang City from Jan.2023 to Jan.2024 were retrospectively analyzed,mNGS and traditional pathogenicity test were performed in BALF,and comprehensive clinical judgment(using a combination of alveolar lavage fluid,sputum,blood,etc.to assess)was used as the gold standard to evaluate the differences between mNGS and traditional pathogenicity tests in the path-ogenic diagnosis of pulmonary infections,compare the pathogen detection rates in pulmonary infections complicat-ed with underlying diseases,severe and non-severe illness and different infection types,and to analyze the impact on clinical adjustment of anti-infection regimens.RESULTS The positive detection rate of mNGS for pulmonary in-fection pathogens was 88.78％,higher than that of traditional pathogenology(P＜0.001).The time required for mNGS was(16.57±2.64)h,shorter than that of traditional pathogenology(P＜0.05).The positive detection rates of mNGS in patients with and without underlying diseases were 93.02％and 85.45％,respectively,higher than those of traditional pathogenology(P＜0.05).The positive detection rates of mNGS in severe and non-severe patients were 91.43％and 87.30％,respectively,higher than those of traditional pathogenology(P＜0.05).A total of 122 strains of pathogens were detected in 87 patients with positive mNGS tests,and EB virus was not de-tected.A total of 75 strains of pathogens were detected in 54 patients with positive traditional pathogenetic tests,and Neisseria,Rhizopus,parvovirus,and Chlamydia psittaci were not detected.The detection rate of bacteria by mNGS was 58.20％,higher than that by traditional pathogenetic tests(P=0.034).The detection rates of mNGS test for monotypic infection and mixed infection were 85.51％and 93.10％,respectively,higher than those by traditional pathogenetic test(P＜0.05).In pulmonary infections,mNGS guided adjustment of anti-infective treat-ment in 53.06％of patients,60.47％of those in the group with underlying pulmonary disease,and 47.27％of those without underlying disease(P=0.194).Among severe cases,68.57％had their anti-infective treatment plan adjusted,compared to 44.44％of non-severe patients(P=0.022).CONCLUSION The mNGS of BALF idenfies some rare pathogens,improves the detection rate of pathogens in pulmonary infections,and may guide the clinical adjustment of anti-infective strategies.

Objective To compare the short-term outcomes of single-port video-assisted thoracoscopic(VATS)pulmonary surgery using a chest-wall-muscle-sparing incision versus a standard incision.Methods A total of 215 patients undergoing single-port video-assisted thoracoscopic lung surgery in the Department of Cardiothoracic Surgery,The First Hospital of Anhui University of Science&Technology from February 2024 to May 2025 were recruited in this clinical observation.Clinical data were retrospectively analyzed.The patients were divided into a chest wall muscle sparing incision group and a chest wall standard incision group.Short-term prognoses of the two groups were compared.Results A total of 180 patients was included:80 in the chest wall muscle sparing incision group and 100 in the chest wall standard incision group.The two groups had similar baseline characteristics,includ-ing body-mass index(23.86±3.70 vs.23.45±3.20 kg/m2;P>0.05).All procedures were completed successfully without perioperative mortality,conversion to thoracotomy,or extension of the incision.The standard incision group had 4 latissimus dorsi injuries and 5 patients with shoulder joint dysfunction on the 30th day after discharge,charac-terized by chest wall muscle tightness accompanied by chest pain and limited upper limb mobility(P<0.05).Although skin-to-skin incision time was slightly longer in the muscle-sparing group(P=0.06),pain scores at every assessed time point were significantly lower(P<0.05),and no patient developed shoulder dysfunction.No significant differences were observed in incisional fat-liquefaction rate,incision length,operative time,blood loss,or chest-tube duration(P>0.05).Conclusion The chest wall muscle sparing incision in single-port video-assisted thoracoscopic lung surgery not only preserves the latissimus dorsi and serratus anterior muscles,significantly reduces postoperative incision pain,and minimizes chest wall muscles and shoulder dysfunction,exhibiting clear minimally invasive advantages in single-port VATS lung surgery.

Objective:To investigate the feasibility, safety, and short-term efficacy of the application of near-infrared fluorescence imaging of tharacic duct(NFITD) by indocyanine green(ICG) in minimally invasive McKeown esophagectomy(MIME).Methods:The clinical data of the patients underwent MIME for esophageal cancer in the First Affiliated Hospital of University of Science and Technology of China From January 2024 to April 2024 were restrospectively analyzed. There were divided into a indocyanine green imaging of thoracic duct(ITD) group and a non indocyanine green imaging of thoracic duct(NITD) group according to intraoperative visualization of morphological patterns of the thoracic duct. The clinicopathologic factors, preoperative adjuvant therapy, surgery-related indicators, postoperative complications were compared between the two groups.Results:In the comparison of general data between the two groups of patients, there were differences in preoperative neoadjuvant therapy between the ITD group and the NITD group. However, there were no significant differences between the two groups in terms of age, gender, tumor segmentation, degree of differentiation, smoking history, drinking history, and preoperative comorbidities. In the perioperative data, the ITD group had advantages in total pleural effusion volume on the third day after surgery, total hospitalization cost, and intraoperative discovery of thoracic duct injury( P<0.05). In terms of the number of metastatic lymph nodes, the ITD group was higher than the NITD group( P<0.05). There were no significant differences between the two groups in terms of operation time, postoperative hospital stay, total pleural effusion volume on the 1st and 2nd days after operation, whether the thoracic duct was ligated, whether there was thoracic adhesion, pTNM stage, the number of lymph node dissection stations and the number of lymph node dissections. In terms of the minor complications of chylothorax after surgery, the ITD group was significantly less than the NITD group. There was no significant difference in other complications between the two groups of patients. Conclusion:NFITD combined with MIME can be safety and effectively performed for patients with esophageal cancer with significant advantages in reducing postoperative chylothorax.