Nashef SAM, Willard J, Mills C
… +5 more, Chiu YD, Noyes P, Petch MC, Couturier DL, Large SR
Eur J Cardiothorac Surg
· 2026 May · PMID 42118099
·
Full text
OBJECTIVES: Safer cardiac surgery is being offered to more high-risk and frail patients, improving both survival and quality of life (QoL) for most. The QoL After Cardiac Surgery Study (QUACS) evaluated QoL changes posto...OBJECTIVES: Safer cardiac surgery is being offered to more high-risk and frail patients, improving both survival and quality of life (QoL) for most. The QoL After Cardiac Surgery Study (QUACS) evaluated QoL changes postoperatively to identify those who do not benefit from and may be harmed by intervention. METHODS: Moderate- and high-risk cardiac surgery patients enrolled in a prospective, national multicentre study (2019-2023). Mortality risk, frailty, outlook, affect, and socio-economic status were objectively measured. Quality of life was assessed preoperatively and to 12-24 months postoperatively. RESULTS: Participants were 2948 patients (EuroSCORE II ≥3 or logistic EuroSCORE ≥6, mean age 72.9 years, female 39.6%). Inclusion criteria were not met in 186 patients, leaving 2762 for analysis. Hospital mortality was 3.93% and 5.86% died after discharge. At 1 year after surgery, net QoL benefit was achieved in 74% of symptomatic patients and in 18% of patients thought asymptomatic. Risk factors for failure to achieve a net QoL benefit were identified, and a preoperative QoL calculator was developed to quantify the likelihood of QoL benefit. CONCLUSIONS: This first study examining QoL changes over time after complex major intervention such as cardiac surgery confirms that some patients do not obtain QoL benefit and helps to identify them. Findings and methodology are applicable to a wide range of major operations. The QUACS Study will improve the process of informed consent and decision-making by patients contemplating such procedures and reduce harmful interventions. CLINICAL TRIAL REGISTRATION NUMBER: NCT04231461 (https://clinicaltrials.gov/study/NCT04231461).
Lorusso R, Matteucci M, Ronco D
… +32 more, Massimi G, Price S, Czerny M, Estévez-Loureiro R, Siepe M, Pontone G, Hassager C, Chioncel O, Zuin M, Davos CH, Adamo M, Gustafsson F, Giannakoulas G, Amabile N, Sionis A, Thielmann M, Petersen SE, Cosyns B, Huber K, Tokmakova M, Pacini D, Klok FA, Saia F, Abreu A, Grimm M, Claeys MJ, García-Álvarez A, Gerber B, Mestres CA, Rosenkranz S, Adamopoulos S, Bonaros N
The prevalence of mechanical complications following acute myocardial infarction has steadily declined in recent years owing to advances in prompt coronary revascularization, and they now occur in <1% of acute myocardial...The prevalence of mechanical complications following acute myocardial infarction has steadily declined in recent years owing to advances in prompt coronary revascularization, and they now occur in <1% of acute myocardial infarction cases. Nevertheless, significant haemodynamic impairment may already be present at hospital admission, requiring immediate diagnostic evaluation and urgent intervention. Until recently, surgical repair was the only treatment option, with non-negligible in-hospital mortality rates, particularly among patients with acute cardio-circulatory failure. Advances in transcatheter percutaneous procedures have now introduced alternative treatment strategies, especially for high-risk or inoperable patients. Recurrence of post-acute myocardial infarction mechanical complications, even shortly after the repair of the underlying lesion, has a critical impact on patient outcome and underscores the need for careful monitoring during hospitalization as well as after discharge. The role of concomitant coronary revascularization remains controversial, with variable effects on both early and late outcomes, and warrants further investigation. Temporary mechanical circulatory support has shown encouraging results, either for pre-procedural haemodynamic stabilization ('bridge-to-procedure') or for prophylactic, extended peri-procedural support to facilitate myocardial recovery ('bridge-to-recovery'). Optimal management should be guided by a multidisciplinary Heart Team approach (including Shock Team involvement where appropriate) with integration of palliative care into the decision-making process.
The European Association for Cardio-Thoracic Surgery (EACTS) Residents' Committee (RC), established in 1996, has become a key driver of trainee representation and innovation in cardiothoracic surgery. Created to address...The European Association for Cardio-Thoracic Surgery (EACTS) Residents' Committee (RC), established in 1996, has become a key driver of trainee representation and innovation in cardiothoracic surgery. Created to address heterogeneity in training across Europe, the RC has helped shape educational standards, promoted resident involvement in governance, and advanced academic development. Through surveys, targeted educational initiatives, and dedicated publication platforms, the Committee has identified persistent challenges while fostering collaboration and scholarship among trainees. Its recent expansion into digital education and global partnerships reflects an evolving role in a rapidly changing field. This Editorial provides an historical overview and highlights the efforts of the RC in training standardization, inclusivity, and international collaboration.
A 69-year-old female underwent remote right upper lobectomy by a surgical team located >8000 km away to evaluate the feasibility and safety of real-time transcontinental uniportal robotic thoracic surgery using a 5G-enab...A 69-year-old female underwent remote right upper lobectomy by a surgical team located >8000 km away to evaluate the feasibility and safety of real-time transcontinental uniportal robotic thoracic surgery using a 5G-enabled serpentine robotic system. The procedure utilized a single-port robotic platform connected via a dedicated 5G network. and completed in 58 minutes with network latency consistently below 150 milliseconds. No intraoperative complications occurred. The patient was discharged on postoperative day 3 without adverse events. This study demonstrates the technical feasibility and safety of transcontinental single-port robotic thoracic surgery under 150 milliseconds latency constraints, supporting its potential to expand global surgical access.
OBJECTIVES: To evaluate the feasibility of single-port (SP) robotic pulmonary resection after neoadjuvant chemoimmunotherapy for non-small-cell lung cancer (NSCLC). METHODS: We retrospectively reviewed data from patients...OBJECTIVES: To evaluate the feasibility of single-port (SP) robotic pulmonary resection after neoadjuvant chemoimmunotherapy for non-small-cell lung cancer (NSCLC). METHODS: We retrospectively reviewed data from patients who underwent SP robotic or SP video-assisted thoracic surgery (VATS) pulmonary resection after neoadjuvant chemoimmunotherapy at Korea University Guro Hospital between March 2018 and November 2025 and compared baseline characteristics, intraoperative and perioperative outcomes, and postoperative complications between the 2 groups. RESULTS: Twenty-four patients were included: 10 in the SP robotic group and 14 in the SP VATS group. Baseline characteristics were comparable, except for histologic type (P = .033) and immunotherapy type (P = .011). One pneumonectomy was performed in the SP VATS group (7%). R0 resection rates were 90% in the SP robotic group and 93% in the SP VATS group (P = 1.000). The conversion rate to thoracotomy was 10% in the SP robotic group and 29% in the SP video-assisted group (P = .358). Other perioperative outcomes, including operative time, lymph node yield, drainage volume, hospital stay length, postoperative complications, and postoperative pain, were comparable between groups. One patient in the SP video-assisted group died of myocardial infarction. CONCLUSIONS: Single-port robotic pulmonary resection after neoadjuvant chemoimmunotherapy is technically feasible and can be performed safely with acceptable perioperative results. Our findings suggest that SP approaches, including robotic and VATS techniques, can serve as viable minimally invasive surgical alternatives for appropriately selected patients with NSCLC.
We report the surgical technique for subxiphoid robotic thymectomy with combined superior vena cava (SVC) resection. A blood-drainage cannula was inserted into the left internal jugular vein as a blood-drainage route. A...We report the surgical technique for subxiphoid robotic thymectomy with combined superior vena cava (SVC) resection. A blood-drainage cannula was inserted into the left internal jugular vein as a blood-drainage route. A blood infusion cannula was inserted into the left femoral vein. During SVC clamping, an assistant pumped blood through the circuit to prevent clotting. The tumour, SVC, thymus, part of the pericardium and part of the right lung were excised en bloc through a subxiphoid incision. We limited reconstruction to the right brachiocephalic-SVC anastomosis. Robotic-assisted thymectomy via the subxiphoid approach enables SVC replacement, which was previously feasible only with open surgery.
Chang ATC, Cho CSY, Chan JWY
… +3 more, Liu W, Lau RWH, Ng CSH
Eur J Cardiothorac Surg
· 2026 Apr · PMID 42102250
·
Full text
OBJECTIVES: This case series aims to evaluate the incidence, mechanisms, and management of bronchopleural fistula (BPF) following transbronchial microwave ablation (TMWA) for lung tumours and to explore innovative strate...OBJECTIVES: This case series aims to evaluate the incidence, mechanisms, and management of bronchopleural fistula (BPF) following transbronchial microwave ablation (TMWA) for lung tumours and to explore innovative strategies for prevention and treatment. METHODS: A retrospective review was conducted on 173 patients who underwent 209 sessions of TMWA from March 2019 to May 2025 at a single centre. Four cases of BPF confirmed by imaging and clinical presentation were analysed. Data collected included procedural details, mechanisms of BPF formation, management strategies, and patient outcomes. Techniques such as intraoperative fibrin glue injection and endobronchial valve placement were documented. RESULTS: BPF occurred in 4 patients (1.9%) and was associated with mechanisms including extensive ablation zone with cavitation, tissue contraction, and inadvertent pleural puncture. Treatments varied from conservative drainage and antibiotics to targeted endobronchial interventions, with all BPF successfully resolved. The use of innovative techniques, such as intraoperative fibrin glue injection, demonstrated promising results with minimal invasiveness. Patients with BPF experienced longer hospital stays compared to those without complications. CONCLUSIONS: Although rare, BPF is a significant complication after TMWA, often requiring individualized management. Early recognition through vigilant monitoring and advanced imaging facilitates prompt intervention. Further prospective studies are needed to refine prevention and management strategies for this serious complication.
OBJECTIVES: To review the prognostic impact of spread through air spaces (STAS) and visceral pleural invasion (VPI) in early-stage non-small-cell lung cancer (NSCLC), assess their relevance to the increasing use of sublo...OBJECTIVES: To review the prognostic impact of spread through air spaces (STAS) and visceral pleural invasion (VPI) in early-stage non-small-cell lung cancer (NSCLC), assess their relevance to the increasing use of sublobar resection, and describe current limitations in their preoperative and intraoperative assessment. METHODS: A comprehensive literature review was conducted to summarize key original studies, meta-analyses, and major clinical trials addressing STAS, VPI, diagnostic modalities, and surgical strategies for early-stage NSCLC. RESULTS: Spread through air spaces is associated with a higher risk of loco-regional recurrence after sublobar resection, and this risk is not adequately reduced by wider surgical margins. Anatomic resection, such as segmentectomy, provides more favourable outcomes than non-anatomic wedge resection in STAS-positive disease. Visceral pleural invasion is associated with an increased risk of distant metastasis, which may contribute to the comparable survival observed between segmentectomy and lobectomy in small VPI-positive tumours. The preoperative and intraoperative identification of both features remains limited due to the low sensitivity of frozen-section analysis for STAS and the modest accuracy of current radiologic predictors. CONCLUSIONS: Tumour size alone is insufficient to guide surgical planning in early-stage NSCLC. Spread through air spaces and VPI have measurable prognostic effects and should be considered when determining the extent of resection. Improved predictive tools and prospective studies incorporating these pathological factors are needed to optimize surgical decision-making and treatment selection.
OBJECTIVES: Neoadjuvant chemoimmunotherapy (nCIT) has rapidly emerged as a transformative treatment strategy for resectable non-small cell lung cancer. This review summarizes current clinical evidence, surgical considera...OBJECTIVES: Neoadjuvant chemoimmunotherapy (nCIT) has rapidly emerged as a transformative treatment strategy for resectable non-small cell lung cancer. This review summarizes current clinical evidence, surgical considerations and ongoing challenges in incorporating nCIT into clinical practice. METHODS: A narrative review of pivotal phase II-III clinical trials was conducted, including CheckMate 816, KEYNOTE-671, AEGEAN and CheckMate 77 T, as well as recent meta-analyses and real-world evidence. Outcomes such as pathological complete response, major pathological response, event-free survival and surgical safety were evaluated. Key controversies-including patient selection, biomarker utility, surgical complexity and the role of adjuvant immunotherapy-were also examined. RESULTS: Phase III trials consistently demonstrated that nCIT improves pathological complete response, major pathological response and event-free survival compared with chemotherapy alone, without increasing perioperative morbidity or mortality. Nonetheless, challenges remain in defining the optimal candidates for nCIT (particularly stage II disease, multi-station N2, for epidermal growth factor receptor-mutant tumours and programmed death-ligand 1-negative tumours). Surgical concerns include nodal fibrosis and altered hilar anatomy; however, major trials have confirmed high R0 resection rates and preserved feasibility of minimally invasive approaches. Biomarker-guided strategies using programmed death-ligand 1 and circulating tumour DNA may refine treatment selection and help guide decisions on adjuvant therapy. CONCLUSIONS: nCIT establishes a new standard of care for resectable non-small cell lung cancer, offering improved pathological and survival outcomes while preserving surgical safety. Future research should focus on unresolved issues such as patient selection, biomarker integration and the role of adjuvant immunotherapy to refine personalized treatment strategies.
OBJECTIVES: Minimally invasive thymectomy has transformed the surgical management of thymic epithelial tumours and myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) is well established, whereas robot-as...OBJECTIVES: Minimally invasive thymectomy has transformed the surgical management of thymic epithelial tumours and myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) is well established, whereas robot-assisted thoracoscopic surgery (RATS) provides technical and ergonomic advantages but at a higher cost. We reviewed current evidence to clarify the indications, oncological validity, perioperative performance, and economic implications of RATS compared with VATS and open thymectomy. METHODS: A structured narrative review was conducted, drawing on multi-institutional cohorts, registry-based propensity-matched studies, and systematic reviews. Evidence was organized by tumour characteristics, special populations (MG, obesity, recurrent thymoma), perioperative and long-term outcomes, surgeon-centred considerations, and cost-effectiveness. RESULTS: In early-stage thymoma and MG, both VATS and RATS achieve R0 resection rates ≥95% and recurrence outcomes comparable with sternotomy. Robot-assisted thoracoscopic surgery is associated with lower blood loss, fewer conversions, and signals of faster recovery, with particular advantages in obese or redo cases. Long-term survival appears equivalent across minimally invasive approaches, without evidence of oncological superiority. However, RATS incurs higher per-case costs, primarily from instrumentation and platform expenses. CONCLUSIONS: VATS remains efficient for straightforward cases, whereas RATS may safely extend minimally invasive eligibility to anatomically complex scenarios while maintaining oncological integrity. Adoption should be indication-driven and resource-conscious. Further multicentre studies with long-term follow-up, patient-reported outcomes, and cost-effectiveness analyses are needed to define the sustainable role of RATS in thymectomy. CLINICAL REGISTRATION NUMBER: Not applicable.
OBJECTIVES: To review the historical evolution, current evidence, and future perspectives regarding lymphadenectomy in non-small-cell lung cancer (NSCLC), with a particular focus on its role in accurate staging, nodal up...OBJECTIVES: To review the historical evolution, current evidence, and future perspectives regarding lymphadenectomy in non-small-cell lung cancer (NSCLC), with a particular focus on its role in accurate staging, nodal upstaging, and therapeutic decision-making. METHODS: This narrative review was conducted through a literature search of PubMed and Scopus from 1950 to March 2025, using the terms non-small-cell lung cancer, lymphadenectomy, nodal upstaging, and mediastinal dissection. Reference lists of relevant studies and guidelines were also screened. Both randomized controlled trials and large observational studies were included, together with international guidelines and recent conference abstracts (Asia-Pacific Innovative Thoracic Surgery Symposium [APITS] 2025). RESULTS: Evidence consistently demonstrates that systematic mediastinal lymphadenectomy enhances staging accuracy, increases the detection of occult nodal disease, and improves prognostic stratification. Pathologic upstaging is a frequent and clinically relevant phenomenon in clinically node-negative patients, directly influencing indications for adjuvant systemic therapy. Guideline-based nodal dissection remains a cornerstone of curative-intent surgery, with at least 3 mediastinal stations and 1 hilar station recommended. Comparative studies show that when a station-based approach is rigorously applied, minimally invasive and robotic techniques achieve staging outcomes equivalent to open surgery. Recent technological innovations, including radiomics, deep learning, and artificial intelligence applied to positron emission tomography/computed tomography (PET/CT) and endobronchial ultrasound, hold promise for refining preoperative risk prediction but remain adjuncts to systematic surgical clearance. CONCLUSIONS: Lymphadenectomy is central to the surgical management of NSCLC. Beyond its role in accurate staging and prognostic assessment, it guides multimodality treatment and underpins long-term outcomes. Future advances are likely to derive not from platform choice but from integrating technology to ensure that systematic, station-based lymphadenectomy is performed safely, consistently, and comprehensively.
OBJECTIVES: There have been many attempts to compare Uniportal Video-Assisted Thoracic Surgery (UVATS) with Multiportal VATS (MVATS) for anatomic lung resection. A review is warranted to appreciate: what has been learnt...OBJECTIVES: There have been many attempts to compare Uniportal Video-Assisted Thoracic Surgery (UVATS) with Multiportal VATS (MVATS) for anatomic lung resection. A review is warranted to appreciate: what has been learnt about the relative benefits of the 2 approaches; what lessons have been learned by the process of comparing approaches; and whether such comparisons should influence surgical practice. METHODS: A narrative review and qualitative analysis of the literature pertaining to UVATS and especially to comparisons between UVATS and MVATS was conducted. RESULTS: The balance of currently published evidence suggests that UVATS offers the following when compared to MVATS: equivalent safety; similar or slightly better post-operative outcomes (especially in reducing pain); equivalent treatment outcomes for lung cancer (measured by lymph node yields and medium-term survival); and broadly similar learning curves. There has been a general trend for studies comparing UVATS with MVATS in recent years to exhibit greater scientific rigor and to investigate a broader range of clinically relevant outcome measures. CONCLUSIONS: Over a decade's worth of comparisons between UVATS and MVATS have validated UVATS as a mainstream approach for minimally invasive pulmonary resections. The direct comparisons have generally suggested non-inferiority vis-à-vis MVATS. However, the true value of the ongoing process of comparison lies in its elevation of good clinical research practices and increasing awareness of those outcome measures most pertinent to patients.
OBJECTIVES: This study aims to evaluate the safety and feasibility of uniportal robot-assisted thoracic surgery for sleeve lobectomy and to analyse the impact of induction therapy on perioperative outcomes. METHODS: Betw...OBJECTIVES: This study aims to evaluate the safety and feasibility of uniportal robot-assisted thoracic surgery for sleeve lobectomy and to analyse the impact of induction therapy on perioperative outcomes. METHODS: Between January 2022 and June 2025, 134 consecutive patients who underwent uniportal robot-assisted thoracic surgery sleeve lobectomy using the da Vinci Xi system were enrolled from a prospective database. Perioperative variables, including patient characteristics, surgical details, pathologic outcomes, and 30-day complications, were analysed. Statistical comparisons were performed between patients who received induction therapy and those who did not. RESULTS: The cohort had a median age of 62 years, with 72.3% having a smoking history. Squamous cell carcinoma was predominant (68.6%), and 55.2% of patients received induction therapy, primarily chemoimmunotherapy. The left upper lobe was the most common resection site (35.1%). R0 resection was achieved in 97.8% of cases. The median operative time was 185 min, and median hospital stay was 6 days. Patients underwent induction therapy was associated with longer operative time (202.5 vs 172.5 min, P = .005) and hospital stay (7 vs 6 days, P < .001) but did not significantly affect blood loss, conversion rate (9.5% vs 6.7%, P = .687), major complications (23.0% vs 26.7%, P = .622), or 30-day readmission (1.4% vs 3.3%, P = .441). There were no 30-day deaths. CONCLUSIONS: Uniportal robot-assisted thoracic surgery sleeve lobectomy is technically safe and feasible, with high R0 rates and acceptable morbidity. Induction therapy prolongs operative time and hospitalization but does not significantly increase perioperative risk. These findings support the adoption of uniportal robot-assisted thoracic surgery for complex sleeve lobectomy, including patients after induction treatment.
OBJECTIVES: The role of upper mediastinal lymph node dissection (UMLND) in distal oesophageal and oesophagogastric junction (AEG) cancers remains debated, requiring a balance between potential oncologic benefit and surgi...OBJECTIVES: The role of upper mediastinal lymph node dissection (UMLND) in distal oesophageal and oesophagogastric junction (AEG) cancers remains debated, requiring a balance between potential oncologic benefit and surgical risk. This review provides an updated perspective on its role. METHODS: We analysed current evidence from retrospective studies, meta-analyses, and ongoing clinical trials, focusing on histology, tumour location, staging, neoadjuvant therapy response, and surgical outcomes. RESULTS: Routine UMLND is not supported for all distal oesophageal and AEG cancers. A standard 2-field dissection is sufficient for most patients with AEG adenocarcinoma. Extended 2-field dissection may be beneficial for squamous cell carcinoma of the upper and middle oesophagus and for adenocarcinoma with high-risk features, such as clinically positive upper mediastinal nodes or bulky abdominal/low-mid-mediastinal nodes. Current evidence highlights the need for a tailored surgical approach rather than uniform application. CONCLUSIONS: UMLND should not be considered routine but applied selectively according to tumour biology, location, and response to multimodal therapy. Future randomized data, particularly incorporating immunotherapy and advanced imaging and surgical techniques, will better define the optimal extent of lymphadenectomy in distinct patient subgroups.
OBJECTIVES: Microaxial flow pumps (mAFP) effectively bridge patients with cardiogenic shock to durable left ventricular assist device (dLVAD) implantation. The partial-support mAFPs provide only up to 3.5 L/min, which mi...OBJECTIVES: Microaxial flow pumps (mAFP) effectively bridge patients with cardiogenic shock to durable left ventricular assist device (dLVAD) implantation. The partial-support mAFPs provide only up to 3.5 L/min, which might be insufficient for an effective circulatory support and preconditioning for a dLVAD implantation. Alternatively, patients with refractory shock on partial support may benefit from an escalation to a full-support mAFP. METHODS: A retrospective analysis of 130 patients was performed across 17 European cardiac centres who underwent dLVAD implantation following mAFP with or without venoarterial extracorporeal life support (VA-ECLS) between February 2015 and August 2022. Ninety-two patients (70.8%) were bridged on partial-support mAFP, while 38 patients (29.2%) underwent an escalation to full-support mAFP. RESULTS: Median support duration was significantly longer in the escalation group (7 days [4, 11] vs 12 days [9, 21], P < .001). Patients in the escalation group were more likely to be weaned from VA-ECLS before dLVAD implantation, 10 (71.4%) vs 6 (11.3%), P < .001. Thirty-day survival was similar between the escalation and no-escalation groups, 89.5% vs 84.8% (IPTW-weighted OR, 1.00 [95% CI, 0.46-2.22], P = .992). Estimated 1-year survival was higher in the escalation group: 84.0% [95% CI, 73.0-96.6] vs 63.7% [95% CI, 54.3-74.6], HR 0.41 [95% CI, 0.17-0.99], P = .048. Patients with a combination of partial-support mAFP and VA-ECLS had a higher mortality risk than all other patients, HR 2.06 [95% CI, 1.16-3.36], P = .013. CONCLUSIONS: In patients with partial-support mAFP and concomitant VA-ECLS, an escalation to a full-support mAFP may translate to improved survival and should be considered to facilitate VA-ECLS weaning.