OBJECTIVES: Optimizing chest drainage management after lung cancer surgery plays a pivotal role in minimizing drainage time and shortening length of hospital stay (LOHS). Currently, a universally acceptable standard is l...OBJECTIVES: Optimizing chest drainage management after lung cancer surgery plays a pivotal role in minimizing drainage time and shortening length of hospital stay (LOHS). Currently, a universally acceptable standard is lacking, and a wide range of drain management strategies are practiced. Therefore, the aim of this systematic review and network meta-analysis (NMA) was to determine an optimal chest drain management strategy following anatomical lung resection on drainage duration, LOHS, and complications, while maintaining patient safety. METHODS: A systematic search was conducted in PubMed, Embase, ClinicalTrials.gov, and Cochrane Library; last search December 2025. Studies were included if they investigated drain management following anatomical lung resection and reported at least one of the following outcomes: drain duration, LOHS, or complications. Network meta-analysis were performed to integrate both direct and indirect comparisons to identify the optimal drain management strategy. RESULTS: Seventeen studies (2004-2023), encompassing 2929 patients, were included in the NMA. Eight distinct drainage strategies were identified based on digital or analogue drainage system, and types of suction: continuous, short-term, alternating suction, or water-seal. In general, digital drainage with alternating suction tended to be associated with shorter drainage duration and LOHS when compared with other drainage strategies. Major complications (Clavien-Dindo ≥3) were reported in 13 studies, varying from 0% to 21%. CONCLUSIONS: Digital drainage systems may reduce drainage duration and LOHS compared with analogue systems. Continuous suction appears less effective than water seal or alternating suction. Due to heterogeneity, firm conclusions are limited and should be interpreted with utmost caution, highlighting the need for standardized high-quality studies.
Schaeffer T, Hayat S, Matsubara M
… +9 more, Palm J, Lemmen T, Heinisch PP, Piber N, Amici A, Hager A, Ewert P, Hörer J, Ono M
Eur J Cardiothorac Surg
· 2026 Jun · PMID 41832988
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OBJECTIVES: Extracorporeal membrane oxygenation is widely used to treat cardiopulmonary failure after congenital heart surgery. This study evaluated patient characteristics, outcomes, and risk factors associated with per...OBJECTIVES: Extracorporeal membrane oxygenation is widely used to treat cardiopulmonary failure after congenital heart surgery. This study evaluated patient characteristics, outcomes, and risk factors associated with perioperative veno-arterial extracorporeal membrane oxygenation use. METHODS: All patients undergoing congenital heart surgery between 2001 and 2024 at our centre were included. Prevalence, outcomes, risk factors for extracorporeal membrane oxygenation support, and predictors of in-hospital mortality following extracorporeal membrane oxygenation were analysed. RESULTS: Among 9892 congenital heart operations, extracorporeal membrane oxygenation was required in 178 (1.8%) patients for a median of 6 days (interquartile range 4-9). Median age and weight at surgery were 2.8 months (interquartile range 0.4-25.2) and 4.1 kg (interquartile range 3.2-8.9), respectively. In patients ≤2 years, the Norwood procedure and surgery for coronary artery malformations were independent risk factors for extracorporeal membrane oxygenation support. Successful weaning was achieved in 62% (n = 111), while 17% (n = 30) required a second extracorporeal membrane oxygenation run. In-hospital mortality after extracorporeal membrane oxygenation was 55% (n = 98), occurring a median of 16 days (interquartile range 5-34) after surgery; 27% of the patients died after a successful first weaning. Model-based predictions showed an 8-fold increase between days 6 and 12 of extracorporeal membrane oxygenation support, with predicted mortality rising from 26% to 74%. CONCLUSIONS: Approximately 2% of patients undergoing congenital heart surgery require extracorporeal membrane oxygenation support with an overall survival rate of around 50%. Prolonged extracorporeal membrane oxygenation duration and acute renal failure requiring renal replacement therapy were independently associated with mortality. The sharp increase in mortality beyond 6 days of extracorporeal membrane oxygenation highlights the need for early reassessment of reversibility and timely consideration of alternative strategies.
OBJECTIVES: The optimal surgical strategy for congenitally corrected transposition of the great arteries (ccTGA) remains debated. This study aimed to compare the long-term outcomes of each surgical approach and to explor...OBJECTIVES: The optimal surgical strategy for congenitally corrected transposition of the great arteries (ccTGA) remains debated. This study aimed to compare the long-term outcomes of each surgical approach and to explore the optimal management strategy. METHODS: We retrospectively reviewed 107 consecutive patients with ccTGA who underwent biventricular repair at our institution between 1978 and 2023. Patients were categorized into 4 groups: atrial switch with arterial switch (AR-A, n = 17), atrial switch with Rastelli (AR-R, n = 59), physiological repair with Rastelli (PR-R, n = 17), and physiological repair with a native pulmonary valve (PR-N, n = 14). The primary end-point was all-cause mortality. Secondary end-points included reoperation, heart failure, arrhythmia, and pacemaker implantation. RESULTS: Median follow-up was 16 years (IQR, 5.2-25). Twenty-year survival did not differ between anatomical and physiological repair (79% vs 82%, P = .97). Among the 4 groups, survival was 94% (AR-A), 75% (AR-R), 86% (PR-R), and 77% (PR-N). Reoperation-free survival was lowest in PR-R (29%) and significantly lower in Rastelli-type repairs (P = .009). Heart failure occurred more often in Rastelli groups. AR-A achieved the most favourable functional outcomes, with preserved systemic ventricular function, the highest maximum oxygen uptake (37 mL/kg/minute), and the lowest brain natriuretic peptide (13 pg/mL). CONCLUSIONS: In this 40-year experience, survival after physiological repair was comparable to anatomical repair. However, AR-A yielded the most favourable long-term functional outcomes and should be considered the preferred strategy when anatomically feasible. Rastelli-type repairs were associated with increased reoperation and heart failure, underscoring the need for refinement of systemic ventricle outflow tract reconstruction techniques.
Liu Z, Ma WG, Liu L
… +2 more, Vallabhajosyula P, Wang H
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41830434
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This statistical primer presents a comprehensive introduction to the use of inverse probability of treatment weighting (IPTW), a method for rebalancing group confounders at baseline in cardiovascular surgical outcomes re...This statistical primer presents a comprehensive introduction to the use of inverse probability of treatment weighting (IPTW), a method for rebalancing group confounders at baseline in cardiovascular surgical outcomes research. We leveraged a retrospective study comparing the outcomes of 2 different surgical approaches to aortic arch pathology to illustrate the essential aspects of performing IPTW, including basic theories, application, extreme weights, underestimated variance, heterogeneity of treatment effect, and multicollinearity. The limitations of IPTW were discussed with examples of solutions. Ten practical recommendations are made on avoiding the pitfalls in the use of IPTW. Proper use of IPTW may effectively reduce confounding bias by balancing confounders between different groups at baseline, retain a relatively large sample size, and allow for integration with other statistical methods. However, it is crucial to be fully aware of its limitations and carefully select appropriate methods to avoid improper use and data misinterpretation in cardiovascular outcomes research.
OBJECTIVES: Surgically implantable bovine jugular vein grafts (Contegra) are widely used for right ventricular outflow tract (RVOT) reconstruction. However, recent studies have reported a high incidence of infective endo...OBJECTIVES: Surgically implantable bovine jugular vein grafts (Contegra) are widely used for right ventricular outflow tract (RVOT) reconstruction. However, recent studies have reported a high incidence of infective endocarditis (IE) associated with Contegra. We evaluated clinical features and risk factors for Contegra IE. METHODS: We retrospectively reviewed the patients who underwent Contegra implantation for RVOT reconstruction between 2016 and 2023. RESULTS: Of the 206 patients, Contegra was used as the first conduit in 161 patients. Median age and weight at operation were 10.8 months and 8.5 kg, respectively. The median diameter of Contegra was 14 mm. Risk factors for decreased time to IE were assessed using Cox regression. During a median Contegra indwelling duration of 43.0 months, 13 patients (13/206, 6.3%) developed IE, at a median of 27.1 months after implantation. Three-year freedom from IE was 94.4%, and the annualized incidence was 1.8% (1.8 cases per 100 patient-years). Gram-positive cocci (11/13, 84.6%) were the most common pathogens. There was one in-hospital death due to fungal IE. Infected conduits were surgically replaced in 11 patients (11/13, 84.6%), during active infection in 8 and after resolution in 3. Higher postoperative conduit peak flow velocity was the only risk factor for IE (hazard ratio [HR] 4.01 per 1 m/s increase; 95% CI, 1.31-12.27; P = .015). A cutoff of 1.45 m/s predicted IE (sensitivity, 84%; specificity, 51%; area under the curve [AUC], 0.67). CONCLUSIONS: IE occurred in 6.3% of patients after Contegra implantation. Higher conduit peak velocity with turbulent flow on immediate postoperative echocardiography was associated with an increased IE risk. IRB APPROVAL DATE: March 24, 2025. IRB REGISTRATION NUMBER: S2024-2302-0001.
D'Onofrio A, Caraffa R, Cibin G
… +10 more, Mangino D, Crea D, Piazza M, Bortolato A, Andreis M, Vedovelli L, Gemelli M, Zanon C, Antonello M, Gerosa G
OBJECTIVES: Endovascular aortic arch repair (Ar-TEVAR) may be a viable option for patients with residual arch pathology after surgery for type A acute aortic dissection (ATAAD). However, anatomical limitations can hinder...OBJECTIVES: Endovascular aortic arch repair (Ar-TEVAR) may be a viable option for patients with residual arch pathology after surgery for type A acute aortic dissection (ATAAD). However, anatomical limitations can hinder its suitability. The primary outcome of this retrospective, dual-centre study aimed to assess the suitability of Ar-TEVAR using 2 branched devices in patients with prior ATAAD repair. METHODS: Patients who underwent surgery for ATAAD at 2 centres between January 2012 and September 2023 were evaluated. The inclusion criteria were prior surgery limited to ascending and/or hemiarch replacement and the availability of a high-quality predischarge computed tomography (CT) scan. Two independent physicians analysed the CT scans to assess suitability for the single-branch NEXUS Aortic Arch Stent Graft System and the double-branch RelayBranch Thoracic Stent-Graft System, based on manufacturers' specifications. RESULTS: Of 465 patients who underwent surgery for ATAAD, 119 (25.6%) were included. Overall, Ar-TEVAR was feasible in 59 patients (49.6%). Device-specific suitability rates were 31.9% for Nexus and 35.3% for RelayBranch, with only 21 patients (17.6%) eligible for both. An inadequate proximal landing zone, often due to surgically modifiable factors such as a too-short or kinked ascending graft, was the primary reason for ineligibility in 48.1% of Nexus cases and 68.8% of RelayBranch cases. CONCLUSIONS: Approximately half of patients with residual aortic arch pathology after ATAAD surgery are eligible for Ar-TEVAR with Nexus and RelayBranch systems. Surgically modifiable factors at the time of the index procedure frequently contribute to ineligibility, highlighting the need for surgical strategies that optimize future endovascular options.
Messina G, Vicario G, Filippo VD
… +10 more, Pica DG, Leonardi B, Giorgiano NM, Iovine A, Vinciguerra R, Capasso F, Chiodini P, Smimmo A, Vicidomini G, Fiorelli A
Eur J Cardiothorac Surg
· 2026 Mar · PMID 41803067
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OBJECTIVES: Intraoperative ultrasound (Io-US) is used during thoracoscopy to detect lung lesions, but it remains underused during robotic-assisted thoracic surgery (RATS), probably due to the difficulty interpreting US f...OBJECTIVES: Intraoperative ultrasound (Io-US) is used during thoracoscopy to detect lung lesions, but it remains underused during robotic-assisted thoracic surgery (RATS), probably due to the difficulty interpreting US findings. We evaluated whether the use of contrast-enhanced ultrasound (CEUS) could improve the diagnostic accuracy of traditional Io-CEUS for detecting lung nodules during RATS. MATERIAL AND METHODS: It was a retrospective single-centre study including all consecutive patients undergoing RATS for management of small, deeply located lung nodules. In all cases, Io-CEUS was used when Io-US failed to detect lung lesion. The diagnostic accuracy of 2 methods to detect lesions and the inter-group differences regarding operative and perioperative outcomes were statistically evaluated. RESULTS: Our study population included 33 patients. Io-US correctly detected 15 out of 33 lesions (45%) but missed 18 lesions with isoechoic patterns that were corrected identified by Io-CEUS with a significant improvement of diagnostic accuracy (difference 55%; 95% confidence interval: 37.56- 71.53; P < .0001). The Io-US group (n = 15) compared to the Io-CEUS group (n = 18) showed no significant differences regarding nodule characteristics such as size (8 mm [7-9] vs 7.8 mm [6-9], P = .78); distance from pleura (32 mm [20-44] vs 21 mm [20-42]; P = .69); lobe location (lower lobe: 66% vs 61%, P = .74); and histological diagnosis (primary lung cancer: 100% vs 88%, P = .18). CONCLUSIONS: Io-CEUS is an additional tool for thoracic surgeons to detect lung lesions and could be useful, especially in cases of isoechoic lesions that were poorly defined by traditional Io-US.
von Meyenfeldt EM, van Oyen D, van den Berg R
… +9 more, van Nassau F, van Leerdam M, de Betue CTI, Barberio L, Schreurs WHH, Marres GMH, Bonjer HJJ, Anema JRH, ERATS Collaborative Group
OBJECTIVES: Enhanced Recovery After Thoracic Surgery (ERATS) protocols aim to standardize perioperative care and improve outcomes in lung cancer surgery. This study evaluated the association between ERATS protocol adhere...OBJECTIVES: Enhanced Recovery After Thoracic Surgery (ERATS) protocols aim to standardize perioperative care and improve outcomes in lung cancer surgery. This study evaluated the association between ERATS protocol adherence and outcomes, primarily length of stay (LOS), in patients undergoing anatomical lung resection. METHODS: The ERATS trial was a prospective, multicentre implementation study across 10 Dutch centres (2020-2023). Adult patients (≥18 years) undergoing anatomical lung resection were included. Adherence to 22 ERATS elements was assessed dichotomously and summarized as a composite ERATS score (0%-100%). Linear regression analysis was used to evaluate the association between ERATS score and log-transformed LOS, logistic regression for complications, readmissions, and mortality. Models were adjusted for clinical covariates. RESULTS: A total of 727 patients were analysed (median age 67 years; 49.4% male). Median LOS: 4 days (interquartile range [IQR] 3-6). Complications occurred in 32.3% (7.4% Clavien-Dindo III-IV); 30- and 90-day mortality were 1.1% and 2.6%, respectively. Mean ERATS score was 63.5% (SD 13.8). Higher adherence was significantly associated with progressively shorter LOS (B = -0.012, P < .001), corresponding to a 21.3% reduction (≈0.85 days at median LOS) per 20-point increase. Higher scores were also associated with fewer complications (odds ratio [OR] = 0.982, 95% confidence interval [CI], 0.969-0.995, P = .007), a 30.5% reduction per 20-point increase. CONCLUSIONS: Higher ERATS adherence was associated with shorter hospital stay and fewer complications. Future efforts should focus on improving compliance-particularly with high-impact elements-to optimize recovery in lung cancer surgery. CLINICAL TRIAL REGISTRATION: NL-010060.
Ha G, Coe L, Jindani R
… +5 more, Rodriguez Quintero JH, Nobel T, Vimolratana M, Chudgar NP, Stiles BM
Eur J Cardiothorac Surg
· 2026 Mar · PMID 41761587
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OBJECTIVES: Wedge resection by video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are minimally invasive techniques commonly used in non-small cell lung cancer management. Altho...OBJECTIVES: Wedge resection by video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are minimally invasive techniques commonly used in non-small cell lung cancer management. Although RATS has been increasingly adopted for anatomical lung resections, it is unclear whether RATS provides any benefit for simple wedge resection. We sought to compare outcomes using both approaches. METHODS: The National Cancer Database was used to identify patients with clinical stage IA non-small cell lung cancer who underwent minimally invasive wedge resection between 2010 and 2022. Outcomes were compared between RATS and VATS. RESULTS: Of 29 064 patients undergoing wedge resection, 7780 (26.8%) underwent RATS and 21 284 (73.2%) underwent VATS. Robotic-assisted thoracoscopic surgery was associated with greater proportions of patients with 4-10 (41.1% vs 25.4%) and >10 lymph nodes removed (16.5% vs 8.3%) compared to VATS, which was associated with more patients having zero (37.2% vs 18.9%) lymph nodes removed. Correspondingly, RATS was associated with higher odds of nodal upstaging (OR 1.34, CI, 1.14-1.59) and higher delivery of adjuvant therapy (OR 1.37, CI, 1.22-1.55). No significant differences were observed in surgical margins, length of stay, readmissions or short-term mortality. Following propensity score matching, increased lymph node sampling was associated with slightly improved 5-year overall survival (70% vs 66%, P < .001, HR 0.93, 95% CI, 0.89-0.98). CONCLUSIONS: Robotic-assisted thoracoscopic surgery was associated with increased lymph node yield, which was also associated with slightly improved overall survival after wedge resection, independent of surgical approach. Given the limitations of the National Cancer Database, the relative contributions of increasing RATS adoption versus broader temporal advances in oncological care cannot be distinguished. Further study of more granular details and cost may better inform approach selection.
Kotanen IM, Selander T, Olsson C
… +6 more, Franco-Cereceda A, Marlevi D, Saari P, Korpela T, Sillanmäki S, Hedman M
Eur J Cardiothorac Surg
· 2026 Mar · PMID 41761586
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OBJECTIVES: The majority of acute type A aortic dissections (ATAADs) occur at ascending aortic dimensions and growth rates below current preventive surgery thresholds. This study aimed to investigate the risk of ATAAD ba...OBJECTIVES: The majority of acute type A aortic dissections (ATAADs) occur at ascending aortic dimensions and growth rates below current preventive surgery thresholds. This study aimed to investigate the risk of ATAAD based on the ascending aortic diameter, length, and their growth rates. METHODS: The ascending aortic diameters and lengths were measured using repeated pre-dissection computed tomography and magnetic resonance imaging acquired during follow-up to evaluate their growth patterns and rates prior to the ATAAD onset. Measurements and growth rates were used to develop the risk function for the ATAAD risk assessment. RESULTS: Ascending aortic aneurysm patients (n = 116) were divided into ATAAD (n = 30) and non-ATAAD groups (n = 86). Almost half of the ATAAD patients (46.7%) did not exceed the current preventive surgery thresholds based on the dimensions. A diameter growth rate of 3 mm/year was extremely rare (2.6%). The risk function was introduced in this study, and it could be used to predict the 5-year risk of ATAAD with excellent confidence (area under the curve [AUC] value of 0.83 (95% CI [0.54-0.98])). CONCLUSIONS: The combination of ascending aortic diameter and length and their growth rates offers a valuable tool for assessing the risk of an ATAAD. Almost half of the ATAAD patients fall below the established thresholds when assessed using only ascending aortic dimensions. These findings suggest that preventive surgery thresholds may benefit from including all four parameters: ascending aortic diameter and length and their growth rates. CLINICAL REGISTRATION NUMBER: DilAo-Trial ClinicalTrials.gov ID 5063566.
BACKGROUND: Endobronchial valves (EBV) improve outcomes in selected patients with severe emphysema but are ineffective in the presence of collateral ventilation. The COVE procedure (closure of collateral ventilation) com...BACKGROUND: Endobronchial valves (EBV) improve outcomes in selected patients with severe emphysema but are ineffective in the presence of collateral ventilation. The COVE procedure (closure of collateral ventilation) combines video-assisted thoracoscopic (VATS) fissure completion with valve placement, enabling therapy in patients otherwise excluded. METHODS: This prospective, ethically approved study planned to recruit 20 patients but closed early due to the COVID-19 pandemic. Thirteen consented, one withdrawing and two proceeding to EBV. Ten consecutive patients underwent the COVE procedure. The primary endpoint was reduction in residual volume; secondary endpoints were changes in FEV₁, modified Medical Research Council dyspnoea score (mMRC), and 6-minute walk distance (6MWD). Survival was analysed using Kaplan-Meier methods and compared with outcomes predicted by the validated BODE Index, incorporating Body Mass Index, FEV₁, mMRC, and 6MWD. RESULTS: The procedure was technically feasible, abolished collateral ventilation in all patients, and had no perioperative mortality. Complications were comparable to standard VATS or endobronchial interventions. Clinically meaningful improvements occurred in residual volume, quality-of-life, and exercise capacity (response rate 7/10, 70%). Based on baseline characteristics, the weighted BODE Index predicted 4-year-survival of 29.7%. Restricted mean survival time was 2.2 years. Observed survival exceeded this, at 80% 4-year-survival. CONCLUSION: The COVE procedure is a novel thoracoscopic-bronchoscopic hybrid that enables valve therapy in patients with collateral ventilation, with encouraging safety, functional, and survival outcomes. Comparison with validated prognostic modelling suggests potential survival advantage, supporting multicentre evaluation to confirm efficacy and optimise patient selection.
OBJECTIVES: Prosthesis-patient mismatch (PPM) and tilted implantation in aortic valve replacement can significantly affect haemodynamics, increasing wall shear stress (WSS) and thrombosis risk. This study uses computatio...OBJECTIVES: Prosthesis-patient mismatch (PPM) and tilted implantation in aortic valve replacement can significantly affect haemodynamics, increasing wall shear stress (WSS) and thrombosis risk. This study uses computational fluid dynamics (CFD) to assess the impact of valve size and implantation angle on blood flow in Medtronic Avalus heart valves. METHODS: Computational fluid dynamics (CFD) simulations were conducted using Ansys Fluent to evaluate 3 Medtronic Avalus valve sizes (23 mm, 25 mm, 27 mm) under 2 leaflet-opening configurations. The simulations incorporated physiological boundary conditions, including a steady inlet velocity of 0.3 m/s and a no-slip wall condition. Wall shear stress (WSS) and general shear stress (SS) thresholds were analysed to assess thrombosis risk. RESULTS: The 25 mm valve reduced the WSS-affected area by 20.83% and the shear stress-affected area by 7.64% compared to the 23 mm valve, demonstrating improved haemodynamics. In contrast, the 27 mm valve increased the WSS-affected area by 41.25% and the shear stress-affected area by 11.26%, with elevated turbulence and recirculation zones near the aortic wall, increasing thrombosis risk. CONCLUSIONS: Moderate upsizing to a 25 mm valve improves haemodynamic performance without introducing adverse flow effects, while further upsizing to 27 mm increases stress and turbulence, raising thrombosis risk.
Rust CJ, Preston JD, Chakragiri A
… +11 more, Tang A, Randhawa SS, Weinberg J, Zhan J, Halkos ME, Bishawi MM, Daneshmand MA, Searles CD, Go YM, Jones DP, Chan JL
Eur J Cardiothorac Surg
· 2026 Feb · PMID 41738347
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OBJECTIVES: Heart transplant primary graft dysfunction, defined as severe ventricular dysfunction within 24 hours after allograft reperfusion, is the leading cause of early mortality following heart transplantation. This...OBJECTIVES: Heart transplant primary graft dysfunction, defined as severe ventricular dysfunction within 24 hours after allograft reperfusion, is the leading cause of early mortality following heart transplantation. This study used plasma metabolomics to identify metabolic signatures associated with severe primary graft dysfunction. METHODS: This single-centre study collected blood samples from 60 adult heart transplant recipients 12 and 24 hours following graft reperfusion. Patients were categorized according to the International Society for Heart and Lung Transplantation guidelines. Samples underwent metabolomics analysis via liquid chromatography-mass spectrometry. Linear models for microarray data were used to identify the metabolic effects of primary graft dysfunction, time, and their interaction, with pathway enrichment analysis and focused analysis of identified metabolites to interpret biological patterns. RESULTS: Among the 60 patients included in this study, 8 developed severe primary graft dysfunction. Severe primary graft dysfunction was associated with coordinated metabolic alterations central to cellular energetics, including altered amino acid and nitrogen handling, broad acylcarnitine accumulation, and selective perturbations of tricarboxylic acid cycle intermediates. Temporal analyses identified divergent metabolite trajectories between groups, with succinate demonstrating the most pronounced divergence over time, reflecting failure to normalize central energy metabolism in severe primary graft dysfunction. Redox-related metabolites demonstrated patterns consistent with activation of antioxidant buffering. CONCLUSIONS: Severe primary graft dysfunction is characterized by a failure to restore cellular energy metabolism, reflected by coordinated upstream substrate accumulation and a distinct temporal pattern of succinate elevation. As an established metabolic signature of ischaemia-reperfusion injury, the succinate trajectory provides a biologically plausible link between impaired energetic recovery and downstream oxidative stress. Although exploratory, these findings support a coherent metabolic framework distinguishing recovery from persistent energetic stress in severe primary graft dysfunction.
Fabbri G, Berjaoui N, Lampridis S
… +6 more, Maraschi A, Harrison-Phipps K, Routledge T, Dell'Amore A, Patel A, Bille A
Eur J Cardiothorac Surg
· 2026 Mar · PMID 41738343
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OBJECTIVES: Lung cancer remains the leading cause of cancer-related death globally. While lobectomy is the standard treatment for early-stage disease, trials have shown that segmentectomy offers comparable survival outco...OBJECTIVES: Lung cancer remains the leading cause of cancer-related death globally. While lobectomy is the standard treatment for early-stage disease, trials have shown that segmentectomy offers comparable survival outcomes for small (≤2 cm) peripheral tumours. Robotic-assisted thoracic surgery (RATS) has gained popularity due to enhanced precision compared with video-assisted thoracic surgery (VATS). However, comparative outcomes of RATS vs VATS segmentectomy remain unclear. This study, therefore, aimed to compare short-term and long-term outcomes in patients undergoing VATS and RATS segmentectomy for non-small cell lung cancer (NSCLC). METHODS: We retrospectively reviewed consecutive patients undergoing RATS or VATS segmentectomy for NSCLC between July 2015 and December 2021. Primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence. Secondary outcomes included complications, length of stay, length of drainage, and lymph-node stations harvested. RESULTS: A total of 144 patients were included (RATS n = 86; VATS n = 58). Baseline characteristics were comparable across groups. RATS was associated with a significantly greater number of lymph-node stations harvested and wider tumour-free margins. Short-term outcomes, including complications, length of stay, drainage duration, conversion rates, and operative time, were similar. Long-term outcomes favoured the robotic approach, with significantly improved OS, DFS, and lower recurrence rates, although multivariable analysis showed no significant difference in hazard ratios between approaches. CONCLUSIONS: RATS segmentectomy demonstrated improved survival metrics and reduced recurrence compared with VATS while maintaining comparable perioperative outcomes. The robotic platform facilitated more extensive lymphadenectomy and wider resection margins, which may underlie the observed oncologic advantages.