Patients undergoing video-assisted thoracoscopic surgery (VATs) for lung cancer (LC) frequently experience prolonged symptoms that can significantly affect their quality of life (QoL).

This study employed a longitudinal observational design. The MDASI and QLQ-C30 were utilized to evaluate symptoms and QoL one day before surgery, as well as at 1 day, 2 weeks, and 1, 2, and 3 months post-surgery. Latent class growth modeling (LCGM) was employed to identify heterogeneous trajectories. By Logistic regression analysis, a score prediction model was developed based on predictive factors, which was internally validated utilizing 1000 bootstrap samples. The SHaply Additive Explanations (SHAP) was used to calculating the contribution of each factor.

205 participants participated in this study. The predominant postoperative complaints included fatigue, shortness of breath, pain, and coughing. Two distinct classes of symptom trajectories were identified: 'severe group' and 'mild group'. Four independent predictors of heterogeneous symptom trajectories were used to develop a scoring model. The area under the receiver operating characteristic curve for this model was 0.742 (95% CI: 0.651-0.832). And the calibration curves demonstrated strong concordance between anticipated probability and actual data (mean absolute error: 0.033). Furthermore, the decision curve analysis (DCA) indicated higher net benefit than other four single factors. SHAP highlighted WBC and surgical duration time as the most influential features.

We established a score model to predict the occurrence of severe symptom trajectories 3 months postoperatively, promoting recovery by advancing rehabilitation plan based on preoperative and surgical situation.

ClinicalTrials.gov (ChiCTR2100044776).

Postoperative pain management is essential after video-assisted thoracoscopic surgery (VATS). The rhomboid intercostal and sub-serratus (RISS) block is effective in providing analgesia. This study aims to determine the minimum effective concentration (MEC) of ropivacaine for ultrasound-guided RISS block in patients undergoing VATS, thereby optimizing the analgesia protocol and enhancing its clinical significance.

The biased coin design sequential method and isotonic regression were used. The ropivacaine initial concentration was 0.25% with a gradient of 0.025%. If the previous patient had a negative block, the concentration for the next patient would increase by 0.025%. If positive, the concentration would be adjusted based on biased coin randomization: an 11% chance of reducing it by 0.025% and an 89% chance of keeping it unchanged. MEC90 was calculated using isotonic regression with 95% confidence intervals (CI).

A total of 49 patients were included in the analysis. The MEC90 of 40mL ropivacaine for RISS block in VATS was 0.220% (95% CI, 0.198 to 0.260%), the MEC95 was 0.248% (95% CI, 0.223 to 0.338%) and the MEC99 was 0.270% (95% CI, 0.261 to 0.351%). There was a negative correlation between ropivacaine concentration and VASpain at 0h, 0.5h, and 6h after surgery and the time of initial analgesia (r = -0.396, -0.594, -0.309, 0.363; P = 0.005, 0.001, 0.031, 0.01). No significant correlation was observed between the VASpain at 12h and 24h after surgery and analgesia consumption (r = -0.184, -0.165; P = 0.205, 0.256).

The MEC90 of 40 mL ropivacaine for RISS block was 0.220%. While the MEC95 was 0.248% and the MEC99 was 0.270%.

Opioids are widely used for anesthesia and postoperative analgesia; however, their use is related to increased risks of untoward effects including hyperalgesia and chronic postsurgical pain (CPSP). We aim to compare opioid-free anesthesia (OFA) with opioid-based anesthesia (OBA) on the incidence of CPSP after video-assisted thoracoscopic surgery (VATS).

This randomized controlled clinical trial was approved by the Medical Ethics Committee of the First Affiliated Hospital of Soochow University, Suzhou, China. A total of 180 adult patients undergoing VATS lung resection will be randomized to receive one of two balanced anesthesia regimens: OFA (dexmedetomidine, esketamine, and sevoflurane) or OBA (sufentanil and sevoflurane). A standardized multimodal analgesia comprises erector spinae plane block, intravenous flurbiprofen axetil, and patient-controlled sufentanil analgesia. The primary outcome is the incidence of CPSP at 3 months after surgery. Secondary outcomes include acute postoperative pain at rest and while coughing (at discharge from post-anesthesia care unit and 6, 24 and 48 hours after surgery), the incidences of postoperative pain at 1 month and 6 months, postoperative 24- and 48-hour sufentanil consumption, adverse events (postoperative nausea and vomiting, headache, dizziness, hallucination, and nightmare), length of post-anesthesia care unit and hospital stay, and the 15-item quality of recovery scores at 48 hours after surgery.

We hypothesize that the OFA strategy would decrease the incidence of CPSP, reduce postoperative adverse events, and enhance quality of recovery following VATS procedures.

Chinese Clinical Trial Registry (ChiCTR2400081099).

This study was designed to evaluate the postoperative frailty status of patients with non-small cell lung cancer, identify influencing factors, establish a machine learning-based prediction model, and explore the correlation between frailty status at 3 months and early recovery at 1 month postoperatively.

This retrospective analysis included patients with non-small cell lung cancer who underwent surgery at our hospital from 2021 to 2024. Clinical variables, including demographics, tumor characteristics, treatment, and laboratory tests, were analyzed. Feature selection and model construction were performed by using LASSO regression. Cross-validation assessed the accuracy of the models. Frailty at 3 months and quality of recovery at 1 month postoperatively were measured by using the Tilburg Frailty Index and Quality of Recovery (QoR-15) scales, respectively.

A total of 1,013 patients were included. The initial model achieved an AUC of 0.833, accuracy of 0.854, recall of 0.382, and F1 score of 0.502 in the training set, and an AUC of 0.786, accuracy of 0.857, recall of 0.242, and F1 score of 0.364 in the validation set. Of the patients, 190 (18.8%) developed frailty at 3 months postoperatively. After applying Synthetic Minority oversampling Technique to balance the data, the model's performance improved (area under the curve [AUC] 0.850, accuracy 0.791, recall 0.818, and F1 score 0.795 for the training set; AUC 0.819, accuracy 0.778, recall 0.762, and F1 score 0.781 for the test set). Additionally, we developed a nomogram to visually represent the predictive model, enabling clinicians to easily assess frailty risk in individuals based on key factors. Correlation analyses showed that frailty at 3 months was moderately negatively correlated with early recovery at 1 month (correlation coefficient = - 0.370).

This study developed a predictive model of postsurgical frailty in lung cancer, providing insights into personalized patient management and early recovery improvement. Further studies should explore the clinical application of the model.

This study aimed to investigate the safety and efficacy of costotransverse foramen block for postoperative analgesia in video-assisted thoracoscopic surgery (VATS).

Seventy-five patients undergoing elective VATS under general anaesthesia were recruited to this double-blind, non- inferiority trial and randomized to preoperatively receive a thoracic paravertebral block (TPVB group), a costotransverse foramen block (CTFB group), or an erector spinae plane block (ESPB group) with 0.5% ropivacaine 20 mL at T5 level. The primary outcome was the postoperative numerical rating scale pain score assessed at 6 h. Secondary outcomes included pain scores at other time points, total opioids consumption at 24 h postoperatively, time to first patient-controlled analgesia pump bolus, number of patients requiring rescue analgesia, dermatomal coverage at 30 min after block, time to perform the block, satisfaction scores of the analgesic effect, block-related side effects, and other complications. The health-related quality of life was evaluated one month after surgery.

The pain scores at 6 h after surgery were 0 (0, 3) in the TPVB group, 0 (0, 2) in the CTFB group, and 4 (3, 4) in the ESPB group. The 95% CI of median difference was 0 to 0 comparing CTFB with TPVB and -4 to -2 comparing CTFB with ESPB. Both the upper 95% CI limits were lower than the predefined noninferiority margin of 1. The pain scores at postanaesthesia care unit, 1 h, 6 h and 12 h after surgery, number of block dermatomes, patient satisfaction scores, time to perform the block as well as the time to first analgesia pump bolus were significantly different between the CTFB group and ESPB group. No differences were detected in other secondary outcomes.

Ultrasound-guided CTFB provided noninferior analgesia compared to TPVB at 6 h after VATS. Additionally, CTFB might provide better analgesia to ESPB although larger confirmatory researches for superiority are further warranted.

Uniportal video-assisted lung resection is increasingly reported, but adoption in North America has been low. This study examines the early experience with the uniportal technique by a surgeon experienced in multiportal thoracoscopic surgery.

Operation was performed using a 4-cm incision crossing the anterior axillary line. Primary objectives were to evaluate short-term outcomes, and secondary objectives included evaluation for learning curve and oncological outcomes for patients with non-small cell lung cancer.

Over a 45-month period, 212 patients underwent uniportal lung resection. Procedures included 128 lobectomies (60.4%), 41 segmentectomies (19.3%), 40 wedge resections (18.9%) and 3 extended resections (1.4%). Conversion was required in 24 patients (12.8%); 17 to multiportal surgery and 7 to thoracotomy. Major adverse events occurred in 13 patients (6.1%) and included 3 deaths (1.4%). Median hospital stay was 3 days, and median chest tube duration was 2 days. When comparing the early and late experience, there was no difference in hospital stay, adverse events, conversion and readmissions. The mean number of lymph nodes and nodal stations dissected were 10.08 and 4.79, respectively. The number of nodal stations dissected improved with experience (P < 0.001).

Uniportal video-assisted lung resection is safe with good perioperative outcomes. Lymph node dissection improved with experience; otherwise, no significant learning curve was demonstrated when transitioning from a multiport approach.

To compare the short-term outcomes and the incidence of post-thoracotomy pain syndrome following dual- versus multi-portal robotic-assisted thoracic surgery.

We retrospectively analyzed a database of 287 patients from two institutions in Japan that perform dual- and multi-portal robotic-assisted thoracic surgery between September 2019 and August 2024. Patients underwent surgery for non-small cell lung cancer and were evaluated for short-term outcomes. Propensity score matching was performed to address differences in the patients' background characteristics between the two surgical groups. Logistic regression analyses were performed to identify the risk factors for post-thoracotomy pain syndrome after robotic-assisted thoracotomy.

Before matching and compared with the multi-portal group, the dual-portal group underwent fewer segmentectomies (p = 0.002) and had fewer dissected lymph nodes (p = 0.014). Patient's characteristics were similar between the groups after matching. There was no significant difference in the short-term perioperative outcomes of both groups. The dual-portal group experienced a significantly lower rate of post-thoracotomy pain syndrome than the multi-portal group (p = 0.038). The predictive factors for post-thoracotomy pain syndrome in the multivariate analysis were multi-portal thoracic surgery and postoperative complications.

The short-term outcomes after dual- and multi-portal robotic-assisted thoracic surgery were comparable. However, multi-portal surgery was a predictive factor for post-thoracotomy pain syndrome.

Thoracic paravertebral block (TPVB) is recommended by the Procedure Specific Postoperative Pain Management (PROSPECT) working group for video-assisted thoracoscopic surgery (VATS). Although perineural magnesium and dextran have been used to prolong block duration, combined use is not reported in the literature. In this case report, the author combined dextran and magnesium with levobupivacaine in TPVB as part of multimodal analgesia for a patient with recurrent lung cancer undergoing VATS, which resulted in satisfactory pain control and sensory blockade up to 3 days postoperatively. Nonetheless, the findings of this study are at most exploratory and call for further research to prove the efficacy and safety of this combination.

Despite global advances in lung cancer treatment, challenges persist in symptom management and supportive care, particularly as the incidence of early-stage diagnoses rises. Patients with non-small cell lung cancer (NSCLC) face symptom burdens compounded by physical, psychological and social factors, alongside the concealment of early-stage symptoms. Research on symptom management in patients with NSCLC remains limited, with a lack of studies exploring patient experiences and clinical management strategies. Moreover, attention to late effects highlights the need for personalised care interventions to address long-term outcomes. The SCAPAS-LungCancer study aims to bridge these gaps by enhancing our understanding of NSCLC symptomatology, late effects and quality of life. The study seeks to identify patients with multiple symptoms and late effects, offering insights for future personalised care interventions to improve patient outcomes and overall well-being.

The study employs a multiple-methods approach encompassing qualitative and quantitative investigations to comprehensively explore symptomatology, patient experiences and treatment outcomes in patients with NSCLC undergoing surgical treatment. A prospective, longitudinal, observational and exploratory design is adopted. A longitudinal qualitative study, including individual interviews and ethnographic fieldwork, will be conducted to explore patients' experiences and interactions with clinicians on symptoms and late effects. Additionally, consecutive newly diagnosed patients with NSCLC scheduled for surgery will be recruited in a prospective questionnaire study using patient-reported outcomes. Eligible patients will complete self-reported measures assessing physical and psychosocial symptom burden and late effects, quality of life, social support and unmet needs at baseline and multiple follow-up points post-surgery over a 2-year period. Socio-demographic and medical characteristics are also collected.

The study is approved by the Danish Data Protection Agency (journal no: 2022-737) and conducted in accordance with Danish Ethics Research Committee guidelines and the Helsinki II Declaration. Participants will provide written informed consent. The results will be reported in peer-reviewed journals.

Background/Objectives: Primary chest wall tumors or malignancies of adjacent organs with chest wall infiltration present a significant challenge for surgical resection and reconstruction. Larger defects involving the sternum, resections in the area of the thoracic apertures, or those near the spine are difficult to reconstruct. The reconstruction has to ensure stability, to prevent paradoxical movements and lung herniation, while also achieving a satisfactory cosmetic result. The "spider web" technique restores chest wall stability by creating a web-like framework made of non-resorbable threads fixed to adjacent bony structures. Additionally, a synthetic mesh is placed over the web construct, and both layers are covered with muscles (local muscles or different types of flaps). In this prospective study, clinical data from patients who underwent surgery using the "spider web" technique were analyzed with respect to chest wall stability, procedure-specific complications, pulmonary function, and patient satisfaction. Methods: A total of 16 patients receiving 18 chest wall resections and reconstructions using the "spider web" technique were followed for at least one year. Chest wall stability and lung function (FEV1 and DLCO) were assessed. Quality of life, cosmetic satisfaction, potential functional impairment, and analgesic consumption were measured using a modified EORTC QLQ-C30 questionnaire. Results: The follow-up period ranged from 12 to 32 months. In all cases, optimal chest wall stability was maintained without impairment of respiratory mechanics. Procedure-specific complications occurred in five cases (27.8%), including seroma (one case), hematoma (two cases), necrosis at the TRAM flap donor site (one case), and mesh infection (one case), all of which were resolved without further complications. Postoperative FEV1 and DLCO were not significantly reduced compared with preoperative values. The global health status score for quality of life was 60 ± 27 points. Nine patients reported being able to ascend at least one floor of stairs without shortness of breath and half of the patients were able to participate in sports activities. One patient required prolonged analgesic medication due to chronic pain. In all cases, patients were satisfied with the cosmetic result. Both 30-day and 90-day mortality were 0%. No local recurrence at the chest wall reconstruction site occurred. Conclusions: The "spider web" technique is a highly suitable method for chest wall reconstruction, allowing covering all types of chest wall defects, regardless of size and location. This cost-effective technique not only provides optimal stability but also good functional results.

Acute pain after thoracoscopic surgery is very noticeable and often requires additional techniques or adjunctive medications to reduce it. We investigated whether intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block could further decrease the incidence of moderate-to-severe pain.

A total of 81 patients were randomly assigned to group C (20 mL normal saline), group S (10 mg dexamethasone + normal saline to 20 mL), or group SM (10 mg dexamethasone + 1 µg/kg dexmedetomidine + normal saline to 20 mL). All patients underwent erector spinae plane block and serratus anterior plane block 30 min before anesthesia induction and all drugs were infused intravenously 30 min after general anesthesia induction. The primary outcome was incidence of moderate-to-severe pain at 24 h on movement postoperatively. Secondary outcomes included incidence of moderate-to-severe pain on movement and at rest throughout the first two postoperative days, pain score, opioid consumption, quality of recovery and adverse effects.

Group SM lowered the incidence of moderate-to-severe pain on movement at 24 h postoperatively than group C (11.1% vs. 48.0%; RR 0.231; 95% CI, 0.074 to 0.725) and group S (11.1% vs. 38.5%; RR 0.289; 95% CI, 0.089 to 0.933). Group SM reduced NRS score on movement (3.0 [3.0] vs. 3.0 [2.0] vs. 3.0[1.0]; P < 0.001) and total opioid consumption (26.0 [6.0] vs. 32.0 [9.0] vs. 28.0 [2.5]; P = 0.004) within 24 h after surgery, fewer patients required rescue analgesia (11.1% vs. 48.0% vs. 38.5%; P = 0.009). Group SM also lowered incidence of nausea and vomiting (7.4% vs. 32.0% vs. 30.8%; P = 0.047) and had a higher QoR-15 score at postoperative 24 h (132.0 [10.0] vs. 123.0 [8.0] vs. 127.5 [10.8]; P < 0.001).

Intravenous administration of dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block further decreased the incidence of moderate-to-severe pain. It also reduced NRS scores and opioid consumption, making the postoperative pain control better for thoracoscopic surgery.

The study was registered at Chictr.org.cn with the number ChiCTR2400084435 on 05/16/2024.

Lung cancer surgery has evolved significantly, with minimally invasive video-assisted thoracic surgery (VATS) procedures being compared with traditional open thoracotomies. The incidence of postoperative wound infections is a significant factor influencing the choice of surgical technique. This systematic review and meta-analysis aim to evaluate the impact of thoracoscopic versus open thoracotomy procedures on postoperative wound infections in lung cancer patients.

Following PRISMA guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on September 19, 2023, without time or language restrictions. Peer-reviewed randomized controlled trials, cohort studies, and case-control studies reporting on postoperative wound infections were included. Studies not differentiating between surgical techniques or focusing on irrelevant populations were excluded. Data extraction and quality assessment were independently carried out by two reviewers, using a fixed-effect model for meta-analysis due to the absence of significant heterogeneity (I2 = 0.0%, P = 0.766).

A total of six articles were included. The quality assessment indicated a low risk of bias in most domains. The pooled results showed that open thoracotomy procedures had a twofold increased risk of postoperative wound infections (OR = 2.00, 95% CI: 1.04-3.85) compared to VATS procedures. Publication bias assessment using funnel plots and Egger's test revealed no significant biases (P > 0.05).

The findings suggest that VATS is associated with a lower risk of postoperative wound infections compared to open thoracotomy, which has implications for surgical decision-making in lung cancer treatment.

Not applicable.

Patients undergoing video-assisted thoracoscopic surgery (VATS) often experience preoperative anxiety, which can significantly impact the surgical process and postoperative recovery. However, the efficacy of Transcutaneous Electrical Acupoint Stimulation (TEAS) in managing preoperative anxiety in VATS patients is unknown.

A total of 82 patients scheduled for thoracoscopic surgery were randomly divided into TEAS group (n = 41) and sham TEAS (STEAS) group (n = 41). The TEAS/STEAS intervention began 3 days before the thoracoscopic surgery, with one session lasting 30 min per day for three consecutive days. The primary outcome measure will be the change in Generalized Anxiety Disorder Scale scores between the day before surgery and the baseline. Secondary outcome include intraoperative anesthetic consumption, time to postoperative chest tube removal, postoperative analgesic consumption and pain scores, length of postoperative hospital stay, serum concentrations of 5-hydroxytryptamine (5-HT), norepinephrine (NE), and gamma-aminobutyric acid (GABA).

On the third intervention day, anxiety levels in the TEAS group were significantly lower than in the STEAS group (p < 0.01). TEAS patients required less intraoperative sufentanil, remifentanil, and dexamethasone (p < 0.01). Chest tube removal time and hospital stay were shorter in the TEAS group (p < 0.01). Postoperative meperidine consumption and VAS pain scores were lower in the TEAS group (p < 0.01). Serum 5-HT levels were lower in the TEAS group on day three (p < 0.01), while NE levels remained lower from day three of intervention to postoperative day three (p < 0.05). GABA levels were higher in the TEAS group (p < 0.01).

TEAS effectively reduces preoperative anxiety, decreases intraoperative anesthetic and anti-inflammatory drug use, shortens postoperative chest tube removal time and hospitalization, and alleviates postoperative pain. These results indicate that TEAS, as an adjunctive therapy, has valuable potential in improving surgical outcomes and postoperative experience for patients with pulmonary nodules.

https://clinicaltrials.gov, NCT04887090.

The analgesic efficacy of esketamine combined with butorphanol in thoracoscopic surgery remains unclear.

This study explored the effects of perioperative esketamine combined with butorphanol versus butorphanol alone on acute and chronic postoperative pain in patients who underwent video-assisted lobectomy.

A total of 181 patients were enrolled, with 90 in the esketamine-butorphanol group (Group BK) receiving intraoperative esketamine infusion and postoperative patient-controlled intravenous analgesia (PCIA) (esketamine 1.5 mg/kg, butorphanol 0.15 mg/kg, azasetron 20 mg). The remaining 91 patients in the butorphanol group (Group B) received normal saline and PCIA with butorphanol (0.15 mg/kg) and azasetron (20 mg). Primary endpoints included Visual Analog Scale (VAS) scores in the first week and chronic pain incidence at three months. Secondary endpoints included intraoperative vital signs, morphine consumption, postoperative adverse events, and 15-item Quality of Recovery-15 (QoR-15) scores.

Group BK demonstrated significantly lower VAS scores within 48 h at rest and within 24 h during coughing postoperatively (P < 0.001). However, no significant differences were observed in VAS scores [(Group B, 5 (0-12)) vs. (Group BK, 5 (0-9)), P = 0.517] or chronic pain incidence [(Group B, 34.1%) vs. (Group BK, 23.3%), P = 0.111] between the two groups at the three-month follow-up. Patients in Group BK exhibited improved postoperative stability of vital signs and higher QoR-15 scores.

Perioperative administration of esketamine significantly mitigates acute postoperative pain and enhances recovery quality in patients undergoing video-assisted lung resection.

This trial protocol is registered with ClinicalTrials.gov (NCT06398834, date: 2024-05-01).

Radical local therapy is effective for oligo-recurrence of non-small cell lung cancer (NSCLC). We retrospectively assessed patients with oligo-recurrent NSCLC and detailed the clinical course after radical local therapy.

We analyzed 1028 patients who underwent complete resection for NSCLC. We defined oligo-recurrence as up to two metachronous recurrences, radical local therapy as local therapy performed with curative intent, and progressive disease as the appearance of new lesions/re-enlargement of the initial recurrence sites.

Of the 132 patients who developed oligo-recurrence, 88 received radical local therapy. Fifty-eight patients had progressive disease. Fifteen patients remained cancer free for > 5 years. Epidermal growth factor receptor (EGFR) positivity was associated with disease progression (odds ratio, 3.90; p = 0.025). Active treatment for disease progression (hazard ratio, 2.54; p = 0.012) and the absence of re-enlarged lesions at sites of radical local therapy for recurrence (hazard ratio, 2.32; p = 0.031) were associated with prolonged post-recurrence overall survival.

Patients with EGFR mutations who develop oligo-recurrence should be monitored for disease progression. Re-enlargement of lesions after radical local therapy was associated with a poor prognosis. A good prognosis can be expected with active treatment, even in the event of disease progression.

Despite the use of multimodal analgesia regimens following video-assisted thoracoscopic surgery (VATS), acute postoperative pain persists. Electroacupuncture (EA) may alleviate acute postoperative pain following VATS; however, current evidence remains insufficient.

This trial will assess the feasibility and efficacy of EA as an adjunctive treatment compared with sham electroacupuncture (SA) for managing acute postoperative pain during coughing after VATS.

In this pilot randomized controlled trial, 60 patients with non-small-cell lung cancer who will undergo VATS will be randomly assigned to either the EA or SA group in a 1:1 ratio. Patients will receive standard care combined with four sessions of EA or SA within 72 h after surgery. The primary outcome will be the average postoperative pain score during coughing, measured using a numeric rating scale within 72 h after surgery. Secondary outcomes will include the average daily pain scores at rest, during coughing, and while mobilizing; incidence of chronic post-surgical pain; quality of life; cough symptom score; and analgesic consumption. All adverse events will be recorded in detail.

This study will determine whether EA as an adjunctive treatment can reduce acute postoperative pain during coughing following VATS.

ClinicalTrial.gov ITMCTR2024000170 (http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=f1a344f7-7e06-4665-ad9d-0917d588eba6).

This meta-analysis aimed to evaluate and compare the outcomes of video-assisted thoracic surgery (VATS) and open thoracic surgery (OT) in the management of pulmonary echinococcosis.

We conducted a comprehensive search of PubMed, Embase, and Cochrane databases for studies comparing VATS and OT. Odds ratios (ORs) for binary outcomes and mean differences (MDs) for continuous variables were calculated with 95% confidence intervals (CIs) using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using I2 statistics.

Seven studies involving 2292 patients were included. VATS demonstrated significant advantages over OT, with reductions in intraoperative blood loss (MD - 81.65 mL, 95% CI - 129.90 to - 33.40), duration of thoracic drainage (MD - 2.29 days, 95% CI - 3.61 to - 0.98), operative time (MD - 45.73 min, 95% CI - 68.41 to - 23.05), narcotic use (MD -3.98 days, 95% CI - 6.21 to - 1.75), length of hospital stay (MD - 3.66 days, 95% CI - 5.66 to - 1.67), postoperative drainage volume (MD - 124.77 mL, 95% CI - 206.27 to - 43.27), and visual analogic score pain at 24 h after surgery (MD - 2.05 points, 95% CI - 2.40 to - 1.70). However, VATS was associated with a higher incidence of atelectasis (OR 3.27, 95% CI 1.03-10.35). No significant differences were observed in other complications, such as bronchopulmonary fistula, surgical wound infection, prolonged air leak, or failure of lung expansion.

VATS was associated with perioperative benefits, including reduced recovery times and resource utilization. Nonetheless, the higher risk of atelectasis suggests OT may remain favorable in complex cases requiring broader surgical access. Tailoring the surgical approach to the patient's needs remains crucial.

International Prospective Register of Systematic Reviews; Nº: CRD42025630187; URL: https://www.crd.york.ac.uk/prospero/ .

Novel non-invasive machine learning algorithms may improve accuracy and reduce the need for biopsy when diagnosing idiopathic pulmonary fibrosis (IPF). We conducted a cost-effectiveness analysis of diagnostic strategies for IPF.

We developed a decision analytic model to evaluate diagnostic strategies for IPF in the United States. To assess the full spectrum of costs and benefits, we compared four interventions: a machine learning diagnostic algorithm, a genomic classifier, a biopsy-all strategy, and a treat-all strategy. The analysis was conducted from the health sector perspective with a lifetime horizon. The primary outcome measures were costs, Quality-Adjusted Life-Years (QALYs) gained, and Incremental Cost-Effectiveness Ratios (ICERs) based on the average of 10,000 probabilistic runs of the model.

Compared to a biopsy-all strategy the machine learning algorithm and genomic classifer reduced diagnostic-related costs by $14,876 and $3,884, respectively. Use of the machine learning algorithm consistently reduced diagnostic costs. When including downstream treatment costs and benefits of anti-fibrotic treatment, the machine learning algorithm had an ICER of $331,069 per QALY gained compared to the biopsy-all strategy. The genomic classifier had a higher ICER of $390,043 per QALY gained, while the treat-all strategy had the highest ICER of $3,245,403 per QALY gained. Results were sensitive to changes in various input parameters including IPF treatment costs, sensitivity and specificity of novel screening tools, and the rate of additional diagnostics following inconclusive results. High treatment costs were found to drive overall cost regardless of the diagnostic method. As treatment costs lowered, the supplemental diagnostic tools became increasingly cost-effective.

Novel tools for diagnosing IPF reduced diagnostic costs, while overall incremental cost-effectiveness ratios were high due to treatment costs. New IPF diagnosis approaches may become more favourable with lower-cost treatments for IPF.

This study compares the analgesic effects of the Thoracoscopic Direct-view Thoracic Paravertebral Nerve Block (DTPVB) with those of the Ultrasound-guided Thoracic Paravertebral Nerve Block (UTPVB), providing a clinical reference.

Sixty-eight patients undergoing three-port video-assisted thoracic surgery (VATS) with general anesthesia were randomly assigned to either the DTPVB group (Group D, n = 34) or the UTPVB group (Group U, n = 34). Both groups received a 10 mL injection of 0.75% ropivacaine at the T4 and T7 interspaces. Primary outcomes were cumulative sufentanil equivalents from the start of lung manipulation to 24 hours postoperatively, with group differences assessed against a non-inferiority margin of 5 μg (Δ). Secondary outcomes include postoperative pain scores, analgesic consumption, patient satisfaction, adverse effects, and other related indicators.

The cumulative use of sufentanil equivalents from the start of lung manipulation to 24 hours postoperatively was 35.0 ± 6.1 μg in Group D and 33.2 ± 5.6 μg in Group U, with no significant difference (P = 0.217). The difference in cumulative sufentanil equivalents (Group D minus Group U) was 1.8 (95% CI -1.07, 4.65), within the non-inferiority margin of 5 (Δ). Postoperative pain scores, analgesic consumption, adverse effects, and complications were similar were similar between groups. However, DTPVB was associated with lower anxiety and higher satisfaction (P<0.001). At 15 minutes post-block, ropivacaine plasma concentrations were higher in Group D (P=0.024).

DTPVB, via transmural pleural puncture, was non-inferior to UTPVB in analgesic efficacy from the beginning of the manipulation of the lungs in operation to 24h postoperatively. DTPVB provides a good alternative, especially for patients who are anxious before surgery, have difficulty cooperating with UTPVB, or in cases where UTPVB puncture fails. However, when using high concentrations of ropivacaine, greater vigilance for toxicity is required.

Until now, the gold standard surgical treatment for early-stage non-small-cell lung cancer (NSCLC) has been pulmonary lobectomy with lymph node dissection. However, several cohort studies have suggested that infra-lobar resection may provide equivalent survival while better preserving quality of life and lung function. The results of two prospective randomized phase III studies comparing sublobar resection (segmentectomy or wedge resection) have recently been published. The JCOG 0802 trial focused on cT1a-b NSCLC and showed significantly better survival in the segmentectomy group, but a higher rate of local recurrence. The CALGB 140503 trial involving stage Ia NSCLC showed no difference in survival and recurrence rate between the two groups. Some questions remain unanswered in these studies, particularly in the CALGB 140503 trial where a majority of patients had an atypical resection. Pending clarification, the complexity of this new surgery calls for oncological rigor in terms of indications and technique, as well as compliance with quality criteria.

Primary lung tumors (PLTs) in children are rare, and surgery remains the key to ensure remission. Here we describe the PLTs clinical characteristics, their management, and the pulmonary outcome following surgery.

We carried out a French national cohort of pediatric PLTs from 2013 to 2023 from the FRACTURE rare pediatric tumors national database. We included children under 18 years at diagnosis who underwent surgery for a histologically proven PLT, with a minimum of 6 months of follow-up (FU) post surgery.

Sixty-two patients were included. The median age at diagnosis was 3.6 years [3; 11], sex ratio 1.07. Pleuropulmonary blastoma was the most frequent tumor retrieved (n = 31). Sixty patients underwent surgery: 32 lobectomies, 15 wedges, five segmentectomies, and five pneumectomies. A thoracoscopic approach was carried out in 14% of the cases. At 6 months post surgery and at the last follow-up (median time of 5.7 years [3.4; 7.6]), respectively, 11 and eight patients presented with pulmonary symptoms, and 10 and three patients presented with surgical complications. During the post-surgery period, 22 children benefited from an evaluation of their respiratory function by pulmonary function tests, and four of them remained with abnormal results.

Surgery is key to ensure remission in PLTs and seems secure. However, respiratory symptoms are noted in 13% of children during the FU, and this rate is probably underestimated. Therefore, we suggest a systematic pulmonary FU to optimize postoperative pulmonary rehabilitation and, therefore, the child's pulmonary outcome.

The choice of surgical procedure for early-stage non-small cell lung cancer (NSCLC) with tumour spread through air spaces (STAS) remain debated. This study aimed to analyse the prognostic influence of STAS on thoracoscopic segmentectomy compared to lobectomy for clinical stage I NSCLC.

This retrospective study included prospectively collected data of consecutive patients who underwent thoracoscopic segmentectomy or lobectomy for clinical stage I NSCLC from September 2020 to September 2023 at a high-volume hospital. We assessed overall survival (OS) and recurrence-free survival (RFS) using Kaplan-Meier estimator with log-rank test. LASSO-Cox and Cox regression analyses identified independent factors for survivals of STAS presence.

Among the 785 patients in the study, 151 (19.2 %) had STAS-positive NSCLC. No significant difference was observed in OS and RFS between patients with the presence and absence of STAS, nor between those undergoing thoracoscopic segmentectomy and lobectomy for NSCLC in the absence of STAS. Whereas worse survivals were found in segmentectomy for patients with STAS when compared to lobectomy (3-year OS: 58.4 % vs 89.0 %, P < 0.001; 3-year RFS: 69.8 % vs 82.7 %, P < 0.001). On multivariable analysis, segmentectomy (vs. lobectomy) and increased maximum standardized uptake value in positron emission tomography were independent prognostic factors of OS (hazard ratio [HR] 5.81, P = 0.010; HR 1.12, P = 0.022) and RFS (HR 5.78, P = 0.004; HR 1.10, P = 0.025) among patients with STAS.

In this study, segmentectomy for clinical stage I NSCLC with STAS had inferior RFS and OS when compared to lobectomy.

This systematic review aimed to evaluate the impact of sublobar resection (SLR) on the quality of life (QoL) of patients with early-stage non-small cell lung cancer (NSCLC). Specifically, it compared outcomes between sublobar resection, lobectomy, and stereotactic body radiation therapy (SBRT).

A literature search was conducted across PubMed and Scopus, identifying studies published from 2010 to 2024 that reported QOL outcomes in early-stage NSCLC patients treated with lobectomy, SLR, or SBRT. Inclusion criteria were studies with more than 10 patients, written in English, and using validated QoL metrics. Data on demographics, interventions, QoL tools, and findings were extracted, and study quality was assessed using the Newcastle-Ottawa Scale and the ROBINS-I tool.

Five studies involving 1,149 patients from six countries met the inclusion criteria. QoL outcomes consistently favored SLR over lobectomy in domains such as physical and respiratory function, with SLR patients experiencing faster recovery and fewer complications. Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS), further enhanced these outcomes. SBRT demonstrated stable QOL post-treatment but lacked the long-term physical recovery benefits observed with SLR. Commonly employed QoL tools included the EORTC QLQ-C30, Leicester Cough Questionnaire, and NSCLC-PQOL, each capturing distinct dimensions of patient QoL status.

Sublobar resection provides significant QoL benefits for selected early-stage NSCLC patients compared to lobectomy, particularly in respiratory health and recovery endpoints. These findings highlight the value of personalized surgical approaches and the need for further research on optimizing QoL in NSCLC management.

Lung cancer is the primary cause of cancer-related mortality globally; hence, several medical and surgical approaches have been developed for its management. This can be easily recognized with the evolution from the traditional open thoracotomy toward minimally invasive procedures-in particular, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS)-in treating lung cancer. There has been a lot of controversy around the advantages and limitations of these procedures. VATS has been proven to be beneficial in treating early-stage lung cancer. Yet, the restricted mobility of its instruments, as well as the lack of a three-dimensional visualization of anatomical components, make the new RATS desired. RATS uses advanced technology, which has resulted in an exceptional high-definition, three-dimensional image of the working field. This has also led to fine dissection with great precision and accuracy, better lymph node removal, reduced postoperative recovery time, and better outcomes. Compared to VATS, there is less blood loss, shorter hospital stays, and less pleural effusion drainage. Despite its higher cost due to the expensive surgical systems, training and maintenance fees, and longer operative time, RATS has started to gain more use, potentially enhancing patient outcomes as experience and technological improvements progress.

Uniportal video-assisted thoracoscopic surgery (U-VATS) and robot-assisted thoracoscopic surgery (RATS) are widely used, minimally invasive procedures. The present study aimed to compare postoperative pain following U-VATS and RATS anatomical lung resection in patients with clinical stage I lung cancer.

We conducted a retrospective analysis of the data from 133 patients with clinical stage I lung cancer who underwent U-VATS (n = 63), four-arm RATS (n = 70) lobectomy, or segmentectomy between August 2020 and August 2023. Early postoperative outcomes, pain scores through postoperative day 7, and duration of postoperative analgesic use 60 days after surgery were compared using propensity score-matched analysis.

In the propensity score-matched analysis, the U-VATS group had a shorter operative time than the RATS group (160 vs. 202 min, respectively; P < 0.001). However, no significant differences were observed in blood loss, chest tube duration, complications, post operative stay length, or number of dissected lymph nodes and stations. The U-VATS group exhibited significantly lower pain scores than the RATS group throughout the entire postoperative period, particularly on postoperative days 1, 2, 3, 4, 5, and 7(P = 0.006, 0.044, 0.032, 0.041, 0.007, and 0.024, respectively). The number of patients who used analgesics for at least 2 months was lower in the U-VATS group than in the RATS group (4 [8.2%] vs. 17 [34.0%], respectively; P = 0.002).

U-VATS anatomical lung resection in patients with clinical stage I lung cancer has less postoperative pain than RATS.

The detection of pulmonary nodules is increasing every year, as well as the need for surgical treatment in more patients, which places a significant burden on surgeons. Surgeon fatigue not only increases surgical risk, but also poses a health hazard to the surgeons. How to reduce surgeon fatigue is an important issue that needs to be addressed urgently.

We collected 917 patients who underwent thoracoscopic surgery between 2022 and 2023. They were categorized into thoracoscopy group, mechanical arm group and pneumatic arm group according to the procedure. Data related to the perioperative period (operative time, blood loss, serious adverse events, etc.) of different patients were retrospectively analyzed. The related scale of fatigue index was also designed to quantify and analyze the fatigue index of doctors.

There were 316, 302 and 299 patients in the thoracoscopic, mechanical and pneumatic arm groups, respectively. There was no statistically significant difference in operative time, bleeding, mean length of hospital stay, and serious adverse events among the three groups. Although there was no significant difference in overall surgical fatigue scores among the three groups, the use of robotic and pneumatic arms significantly reduced the fatigue of surgeons and assistants in complicated surgeries.

Compared to traditional thoracoscopic surgery, the application of surgical assistance robotic arm does not increase perioperative risk. Moreover, in longer thoracoscopic procedures, it significantly reduces fatigue for both the surgeons and their assistants. However, current robotic arms still have certain limitations and require continuous improvements to better meet clinical demands.

Advancements in diagnostic imaging and surgical techniques have significantly evolved the treatment landscape of non-small cell lung cancer (NSCLC). The shift toward parenchymal-sparing approaches, such as segmentectomy for cT1a-bN0 tumors, is challenging the traditional lobectomy. This retrospective multicenter cohort study evaluates short-term outcomes of Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) in NSCLC patients using data from the French EPITHOR registry, enhanced by an in-depth quality audit. The audit ensured the completeness and accuracy of the data by monitoring and improving the quality of data entry at participating centers. We included patients who underwent mini-invasive lobectomy or segmentectomy between January 2016 and December 2020. The primary outcome was the length of hospital stay (LOS), with secondary outcomes including complications, 90-day rehospitalization, and mortality. A total of 5687 interventions were analyzed, including 3692 VATS and 1995 RATS procedures. The unadjusted mean LOS was slightly shorter for RATS (7.61 days) compared to VATS (8.04 days), though this difference was not statistically significant after adjustment (p = 0.073). No significant differences were found in secondary outcomes, including complication rates and 90-day mortality. The integration of a comprehensive quality audit allowed for a robust comparison of outcomes, ensuring reliable and accurate data across all centers. While RATS showed a trend toward shorter hospital stays, this study did not find statistically significant differences in short-term outcomes between RATS and VATS after adjusting for confounders. Both RATS and VATS are viable options for lung resections, with the choice potentially guided by surgeon expertise and institutional resources.

Minimally invasive surgery (MIS) reduces lengths of stay, complications, and potentially perioperative hospital costs. However, the impact of MIS on financial toxicity (FT), defined as the costs resulting from oncologic care and their negative effects on quality of life, in patients with lung cancer is unknown. Our objective was to investigate the association between surgical approach and FT in this population.

A single-institution study was performed evaluating resected lung cancer patients (2016-2021). FT was assessed using the Comprehensive Score for Financial Toxicity (COST) questionnaire. The relationship between surgical approach (MIS vs. thoracotomy) and FT was evaluated using propensity score-matched (PSM) regression analysis. A sensitivity analysis involving the entire cohort was also performed using an inverse probability-weighted generalized linear model.

As reported previously, of 1477 patients surveyed, 463 responded (31.3%) with FT reported in 196 patients (42.3%). Resection was performed by thoracotomy in 53.3% (n = 247), and by MIS in the remainder (n = 216, 46.7%; video-assisted thoracoscopic surgery [VATS] = 115; robotic-assisted = 101). There was no difference in FT in patients who underwent VATS and robotic-assisted surgery (p = 0.515). In the PSM analysis, MIS was not associated with FT (odds ratio [OR]: 0.980, 95% confidence interval [CI]: 0.628-1.533, p = 0.929). Similar results were found on sensitivity analysis (OR: 1.488, CI: 0.931-2.378, p = 0.096).

Compared to MIS, thoracotomy was not associated with FT in patients with resected lung cancer. Though there are several benefits from MIS, it does not appear to be a meaningful strategy to alleviate FT in this population.

Ultrasound-guided intercostal nerve block (UINB) and thoracoscopic-guided intercostal nerve block (TINB) are often used for analgesia after thoracic surgery. Herein, we compared the application of TINB and UINB for analgesia after uniportal video-assisted lobectomy.

Sixty patients were randomly allocated into two groups: UINB and TINB. The surgical time of intercostal nerve block (INB), the success rate of the first needle, visual analog scale (VAS) scores, the time of the first patient-controlled intravenous analgesia (PCIA) press, the time for removing the thoracic drainage tube, consumption of sufentanil and the number of PCIA presses within 24 hours postoperatively, and adverse reactions (ARs) were compared between the two groups.

The surgical time of INB was significantly shorter in the TINB group than in the UINB group ( P < 0.001). The time of the first press of PCIA was significantly earlier in the TINB group than in the UINB group ( P < 0.001). The success rate of the first needle was significantly higher in the TINB group than in the UINB group ( P < 0.001). No significant differences were observed between the two groups regarding VAS scores, time for removing the thoracic drainage tube, the consumption of sufentanil, the number of PCIA presses within 24 hours postoperatively, and ARs.

TINB and UINB have similar analgesic effects after uniportal video-assisted lobectomy. However, TINB demonstrates shorter surgical time and a higher success rate than UINB.

The cost benefit of intercostal nerve cryoablation during surgical lobectomy for postoperative pain management is unknown. The current study compared hospital economics, resource use, and clinical outcomes during the index stay and accompanying short-term follow-up. Patients who underwent lobectomy with standard of care treatment for postsurgical pain management and cryoablation were compared to those with standard of care treatment only. We hypothesized that cryoablation would reduce narcotic use and index hospital and short-term costs.

A retrospective, propensity matched cohort of surgical patients treated between 2016 and 2022 from a US National All-Payer Database were used. Cost and outcome comparisons were made between groups using chi-square and t tests.

From a cohort of 23,138 patients, 266 pairs with a mean age of 69 years were included. Matching variables included age, gender, lobe resected, and prior opioid use. Both groups had significant comorbidity history and prior opioid use; 66% (n = 175 both groups) underwent open lobectomy and 53% (n = 142 vs. 143) had the upper lobe resected. Cryoablation intervention was associated with 1.3 days reduced hospital stay (8.8 vs. 10.1 days, p = 0.31) and no difference in perioperative safety. After 90 days, postsurgery cryoablation patients had lower opioid prescription refills (27.3 vs. 36.9 morphine milligram equivalents, p = 0.03). Cryoablation patient costs trended less than non-cryoablation patients during index ($38,753 vs. $43,974, p = 0.10) and lower through 6 months (total costs, $65,703 vs. $74,304, p = 0.10). There was no difference in postsurgery resource use, but a smaller proportion of cryoablation patients had outpatient hospital visits (83.1%, N = 221 vs. 92.9%, n = 247, p < 0.01).

Cryoablation during lobectomy is safe and does not add incremental hospital costs. Clinical meaningful reductions in length of stay and postsurgery opioid use were observed with cryoablation intervention. The addition of cryoablation during surgery to reduce postoperative pain appears to be a cost-effective therapy.

Video-assisted thoracoscopic surgery (VATS) has been widely used for low invasiveness and shorter recovery time. However, patients receiving VATS still experienced moderate-to-severe pain even under both regional and systemic analgesia. Little is known on the effect of non-pharmaceutical method with physical stabilization for post-VATS pain control. The study aims to investigate the feasibility of physical stabilization as a surrogate method for pain control. The single-blinded, randomized-controlled trial recruited the patients into physical stabilization group and standard care group after VATS. The patients in the intervention group tied a thoracic belt for all day, while the control group did not. Both groups had intravenous patient-controlled analgesia (IVPCA) and on-demand oral analgesics. The primary outcome was the visual analogue scale for pain at the 6th, 24th and 48th hour post-VATS and at the hospital discharge. There were 18 patients assigned to the interventional group and 18 patients assigned to the control group. Four patients in the control group were dropped out from the study. Physical stabilization was found to enhance the analgesic effect post-operative 24-48 h compared to standard care (Difference of VAS: 1.11 ± 0.68 v.s. 0.5 ± 0.86, p = 0.031). It had no effect on the dose of IVPCA or the use of oral analgesic agents. No complications direct to the thoracic belt or adverse outcome from the surgery were found in the study. Physical stabilization with thoracic belt to patients receiving VATS benefits to pain control, especially between the 24th and 48th hour post-VATS. Clinical Trial Registry number: NCT04735614.

Hospital admissions often result in functional decline for patients with dementia, yet evidence on the impact of cancer treatments in this population during hospitalization is limited. We aimed to examine the association between dementia and functional decline after cancer treatment in patients with non-small cell lung cancer (NSCLC).

A total of 30,213 patients aged 65 years or older hospitalized for NSCLC treatment, from a dataset of 366 acute care hospitals in Japan, were eligible for this study. The primary outcome was activities of daily living (ADL) at discharge, assessed using the Barthel Index, with a total score ranging from 0 to 100, and the secondary outcome was the length of hospital stay. We conducted causal mediation analysis by cancer treatment within a counterfactual framework using the g-formula approach with direct counterfactual imputation. Bias-corrected and adjusted bootstrapped 95 % confidence intervals (CIs) were calculated based on 100 bootstrap samples. Dementia status served as the exposure, ADL scores at admission as the mediator, and ADL scores at discharge as the outcome. Covariates measured at admission were used to adjust for dementia status. Subgroup analyses were performed by treatment group including surgery.

Compared with patients with NSCLC who did not have dementia, those with dementia exhibited lower ADLs at discharge across most cancer treatments, regardless of ADL scores at admission. Patients with dementia who underwent chemotherapy had prolonged hospital stays of 2.90 days longer (95 % CI, 1.27 to 4.52) and lower ADL scores at discharge than their counterparts without dementia (-9.77 [95 % CI, -12.55 to -7.00]). Similarly, patients with dementia who received radiotherapy experienced lower ADL scores at discharge compared with those without dementia (-15.06 [95 % CI, -19.59 to -10.54]), with no difference in the length of hospital stay (-0.54 [95 % CI, -2.84 to 1.75] days). Similar findings were observed from the total effects after adjusting for potential confounders.

Patients with comorbid cancer and dementia consistently displayed lower ADL scores at discharge following various cancer treatments. Understanding the effects of dementia on functional decline may aid in making optimal treatment choices for inpatient care for patients with NSCLC.

Pulmonary tuberculosis (TB) remains a significant cause of morbidity and mortality worldwide, particularly in resource-limited settings. Bronchopleural fistula (BPF) is a rare yet life-threatening complication of TB, presenting substantial diagnostic and therapeutic challenges. Its effective management demands a multidisciplinary approach, especially when compounded by concurrent infections and severe malnutrition. We present the case of a 39-year-old male with a history of chronic alcohol use and heavy smoking, who presented with severe cachexia, pneumothorax, and a persistent air leak. Diagnostic evaluations confirmed TB complicated by BPF and superinfection with Streptococcus pneumoniae. Despite initiating antitubercular therapy, antibiotics, and thoracic drainage, the patient's condition deteriorated rapidly. Given the high surgical risk, conservative measures, including single-lung ventilation and supportive care, were employed. However, his clinical course was marked by progressive respiratory distress, refractory septic shock, and multiorgan failure. Despite exhaustive supportive efforts, the patient succumbed to the illness on the eighth day of hospitalization. This case underscores the complexities of managing TB-associated BPF, particularly in patients with severe malnutrition and coexisting infections. It highlights the critical need for early diagnosis, individualized interventions, and close multidisciplinary collaboration to optimize outcomes in such challenging scenarios.

Incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely in hand therapy practice.

(a) Explore correlations between body functions, activities and participation (A&P), and quality of life (QOL); (b) assess the extent to which personal factors and body functions contribute to variations in A&P and QOL; (c) compare the QOL of individuals with and without hand impairment (HI).

Cross-sectional.

Seventy-seven patients (Mean age=43.70 SD=17.56; 47 males and 30 females) with chronic and acute hand impairment were recruited from two hand clinics and matched with healthy participants. Assessments were administered to participants in their first visit to the hand clinic. QOL was measured with the World Health Organization QOL questionnaire; A&P with the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire; pain with the Patient-Rated Wrist/Hand Evaluation; hand function with The Functional Dexterity Test, Jamar Dynamometer and Pinch Gauge.

Significant correlations were found between QOL and A&P, dexterity, and pain, as well as between A&P and hand strength and pain. Personal factors, hand function, and pain collectively explained 28.9% of QOL variance and 61.4% of A&P variance. Pain emerged as the sole significant contributor to QOL variance, while both hand function and pain significantly influenced A&P variance. Comparisons between the study group and controls highlighted significant differences in QOL domains, with the HI group reporting lower perceived QOL in physical, social, and environmental domains.

The significance of adopting a comprehensive approach in HI intervention was highlighted. A complex interplay of factors across different levels of the International Classification of Functioning, Disability and Health (ICF) framework imply that clinicians should avoid fixating exclusively on isolated factors or specific domains.

Chronic post-thoracic surgery pain (CPTSP) is a common complication that affects a patient's quality of life. Thoracotomy is associated with a high risk of chronic pain. Video-assisted thoracoscopy surgery (VATS) is a less traumatic option, but its role in the development of CPTSP is unclear. Regardless of the approach, there is evidence that demographic, psychosocial, or clinical factors also contribute to pain. The primary objective of this study is to determine the incidence of CPTSP in our hospital. The secondary objective is to identify possible risk factors related to CPTSP.

Retrospective, single-centre observational study. The medical records of patients that underwent thoracic surgery between January 2016 and January 2020 were reviewed. The diagnosis of CPTSP was made by reviewing the postoperative visits 6 months after surgery. We analysed the relationship between CPTSP and a series of variables, and then constructed a multivariate binary logistic regression model with a significance level of p < 0.05.

A total of 259 patients were analysed, 46.7% underwent VATS and 53.3% underwent thoracotomy. The overall incidence of CPTSP was 12%; 4.1% in VATS and 18.8% in thoracotomies. The multivariate model revealed that moderate-to-severe acute postoperative pain and a greater number of chest tubes were risk factors for CPTSP.

The incidence of CPTSP was 12% in our hospital. Patients with higher acute postoperative pain severity and several chest tubes were more likely to develop CPTSP.

Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection.

This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3 mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20 ml. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0.

The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR ( P =0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI: 4.0-8.1; P <0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI: 0.2-4.9; P =0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0).

For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.

Postoperative pain following video-assisted thoracoscopic surgery (VATS) remains a significant challenge. While epidural analgesia is still the gold standard, other types of regional analgesia are gaining popularity because of perceived less risk of complications. The efficacy of systemic opioids as an alternative to epidural analgesia has not been thoroughly explored. This systematic review and meta-analysis aims to evaluate and compare the efficacy of systemic opioids versus epidural analgesia in managing postoperative pain after VATS.

We will conduct a systematic review and meta-analysis in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. A comprehensive search will be conducted in MEDLINE, EMBASE, and the Cochrane Library supplemented with Scopus citation searches, search for gray literature using Google Scholar and a search for ongoing studies. We will include studies based on the PICO methodology without restrictions regarding study type. Two independent reviewers will screen studies, extract data, and assess study quality using the Cochrane Risk of Bias tools. The primary outcomes will be postoperative pain intensity at rest and during activity at 24, 48, and 72 h. Secondary outcomes will include use of "rescue" opioids, hospital length of stay, and adverse events. If feasible, a meta-analysis will be done, otherwise we will perform a descriptive analysis.

The results will provide a comparative analysis of the effectiveness of systemic opioids versus epidural analgesia in managing postoperative pain in VATS patients. Data synthesis will include pooled estimates for pain scores, opioid consumption, and adverse events, possibly with subgroup and sensitivity analyses conducted to explore heterogeneity across studies.

This systematic review will offer valuable insights into the optimal pain management strategy for patients undergoing VATS. The findings may guide clinical practice in selecting the most effective and safe analgesic approach, improving postoperative recovery, and patient outcomes.

Video-assisted thoracoscopic (VATS) lobectomy can affect patients' pulmonary function and quality of life significantly. No optimal protocol combining patient-reported outcome-based symptom management and postdischarge rehabilitation programme has yet been established. This study aimed to assess the efficacy of a novel smartphone app designed for home-based symptom management and rehabilitation.

The app was developed based on three modules: a symptom reporting system with alerts, aerobic and respiratory training exercises, and educational material. Four core symptoms were selected based on a questionnaire survey of 201 patients and three rounds of Delphi voting by 30 experts. The authors screened 265 patients and randomly assigned 136 equally to the app group and usual care group. The primary outcome was pulmonary function recovery at 30 days postoperatively. Secondary outcomes included symptom burden and interference with daily living (both rated using the MD Anderson Symptom Inventory for Lung Cancer), aerobic exercise intensity, emergency department visits, app-related safety, and satisfaction with the app.

Of the 136 participants, 56.6% were women and their mean age was 61 years. The pulmonary function recovery ratio 1 month after surgery in the app group was significantly higher than that in the usual care group (79.32 vs. 75.73%; P =0.040). The app group also recorded significantly lower symptom burden and interference with daily living scores and higher aerobic exercise intensity after surgery than the usual care group. Thirty-two alerts were triggered in the app group. The highest pulmonary function recovery ratio and aerobic exercise intensity were recorded in those patients who triggered alerts in both groups.

Using a smartphone app is an effective approach to accelerate home-based rehabilitation after VATS lobectomy. The symptom alert mechanism of this app could optimise recovery outcomes, possibly driven by patients' increased self-awareness.