Colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer-related mortality worldwide. A total of 20% of CRC patients present with distant metastases, most frequently to the liver and lung. In the primary tumor, as well as at each metastatic site, the cellular components of the tumor microenvironment (TME) contribute to tumor engraftment and metastasis. These include immune cells (macrophages, neutrophils, T lymphocytes, and dendritic cells) and stromal cells (cancer-associated fibroblasts and endothelial cells). In this review, we highlight how the TME influences tumor progression and invasion at the primary site and its function in fostering metastatic niches in the liver and lungs. We also discuss emerging clinical strategies to target the CRC TME.

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality. Exploration of the tumor microenvironment (TME) has resulted in dramatic advancements in the treatment of NSCLC through the advent of immunotherapy. Indeed, anti-programmed death (PD) ligand 1/PD-1 checkpoint inhibitor therapy has substantially improved survival for advanced, unresectable disease and is now being increasingly utilized in the perioperative setting for early-stage, resectable tumors. This success has generated vigorous interest in exploring other cellular players in the NSCLC TME that could be potentially targeted for therapeutic benefit. In this review, we discuss the current state of therapeutic targets in the NSCLC TME, reflect on the revolution of immunotherapy and future directions for its utilization, and reflect on how the current investigations into TME-specific targets may impact thoracic surgical care.

Robotic-assisted thoracoscopic surgery (RATS), an evolution of minimally-invasive video-assisted thoracoscopic surgery (VATS), has recently emerged as the standard of care approach for pulmonary lobectomy for lung cancer. Despite increased upfront costs, RATS provides high-resolution, three-dimensional visualization of the operative field and enhanced instrument maneuverability with greater degrees of freedom. Several studies have demonstrated that RATS is non-inferior to VATS and may be associated with more complete mediastinal lymph node dissection and reduced risk of open conversion, length of stay, and intraoperative blood loss. In this chapter, we discuss the fundamental principles of robotic-assisted pulmonary lobectomy, indications and advantages of a robotic approach, and our operative technique.

Tricuspid valve infective endocarditis (TVIE) comprises 5–10% of all endocarditis cases and is more prevalent with the recent and ongoing opioid and intravenous drug epidemic, as well as increased placement of intracardiac devices. New technologies have been developed to manage tricuspid valve (TV) vegetations in an evolving population. In this chapter, we provide comprehensive review of age-old treatment modalities for TVIE as well as a discussion of advanced TV repair and replacement modalities and alternatives to surgery. We examine critical management nuances including optimal surgical technique based on a variety of patient-related factors, ideal operative timing, medical and surgical management of septic emboli, managing patients with prior percutaneous TV interventions and current TVIE, and emerging treatment techniques for TVIE. We aim to provide a framework for the multi-disciplinary care of TVIE in a changing patient and technology landscape.