Pulmonary carcinosarcoma (PCS) is a rare neoplasm. This study explored the clinicopathological characteristics and survival outcomes of PCS. The Surveillance, Epidemiology and End Results (SEER) database (1988–2014) was queried for PCS. Overall survival (OS) was evaluated by multivariable Cox regression and nomograms were constructed to predict 3-year OS for PCS. Prognostic performance was evaluated using concordance index and area under the curve analysis. In M0 surgically treated patients, interaction assessments were performed using likelihood ratio tests. Subgroup analysis was performed according to patient age. The clinical features of PCSs were further compared to other non-small-cell lung cancers (NSCLCs). Multivariable analysis identified age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01–1.04], surgery (HR 0.53, 95% CI 0.36–0.77) and chemotherapy (HR 0.51, 95% CI 0.36–0.73) as significantly associated with OS. The nomogram had a concordance index of 0.747 and an area under the curve of 0.803. The association between age and OS was stronger in those receiving pneumonectomy (P = 0.04 for interactions) compared to those that did not (HR 5.14, 95% CI 1.64–16.07), and was associated with a poorer outcome compared to lobectomy amongst the elderly (age ≥ 70 years). Patients with PCS were more likely to receive surgical treatment and had lower lymphatic metastasis compared to adenocarcinoma, squamous cell carcinoma and large cell carcinoma (all P < 0.05). PCS had unique clinical features compared to common types of NSCLCs in terms of lymphatic invasion and surgical treatment. Pneumonectomy was associated with poorer survival in elderly patients.

Lung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special airway management strategy. A 48-year-old woman who had left pneumonectomy 2 years ago was scheduled to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS). A 32-French (Fr) left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff’s inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma. Lung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the implementation of the operation mentioned above could be solved.

Herein, the effect of pre-use of Dexmedetomidine(Dex) on the half-effective dose (ED50) and 95%-effective dose (ED95) of Remimazolam tosilate(RT) in inhibiting the positive cardiovascular response(CR) which means blood pressure or heart rate rises above a critical threshold induced by double-lumen bronchial intubation was evaluated. Patients who underwent video-assisted thoracic surgery were divided into groups A (0), B (0.5 µg/kg), and C (1 µg/kg) based on different Dex doses. Group A included subgroups comprising young (A-Y) and elderly (A-O) patients. Neither groups B nor C included elderly patients due of the sedative effect of Dex. Based on the previous subject’s CR, the dose of RT was increased or decreased in the next patient using the sequential method. This trial would be terminated when the seventh crossover occurred, at which point the sample size met the stable estimate of the target dose. Heart rate (HR) and mean arterial pressure (MAP) were monitored throughout the trial, and sedation was assessed using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale. HR and MAP were recorded at baseline (T1), the end of Dex (T2), and the end of RT (T3), the maximum HR and MAP were recorded within 3 min of intubation from beginning to end (T4). There was a positive CR when the T4 levels rose above 15% of the baseline. The ED50/ED95 and corresponding confidence interval were calculated using probability regression. In total, 114 patients completed the trial. Without the use of Dex, the ED50/ED95 of TR inhibiting the positive CR caused by double-lumen bronchial intubation was 0.198/0.227 and 0.155/0.181 mg/kg in groups A-Y and A-O, respectively. The changes in vital signs from T1 to T3 were similar in the subgroups, indicating that the elderly patients were more sensitive to the dose of RT. The ED50/ED95 of RT inhibiting the positive CR caused by double-lumen endobronchial intubation was 0.122/0.150 and 0.068/0.084 mg/kg in groups B and C, respectively. And, the fluctuation of blood pressure from T3 to T4 was reduced by using Dex. RT was 100% effective in sedation with no significant inhibition of circulation. Apart from one case of hypotension occurred in group A-Y, two cases of low HR in group B, and one case of low HR in group C, no other adverse events were noted. The optimal dose of RT to inhibit positive CR induced by double-lumen bronchial intubation in elderly patients was 0.18 mg/kg and 0.23 mg/kg in younger patients. When the pre-use dose of Dex was 0.5 µg/kg, the optimal dose to inhibit positive CR of RT was 0.15 mg/kg. And, when the pre-use dose of Dex was 1 µg/kg, the optimal dose of RT was 0.9 mg/kg. NCT05631028.

For bronchial sleeve and carinal resection and reconstruction during uniportal video-assisted thoracic surgery (VATS), ventilation technique remains a demanding challenge for the anesthesiologists. The ventilation techniques require maintaining adequate gas exchange while providing a good surgical exposure. The case we present was a 58-year-old female with carcinoma in the right upper lobe involving the right main bronchus and the lower trachea. Right upper sleeve lobectomy, carinal resection and reconstruction was performed under uniportal VATS. A modified double-lumen tube (DLT) was inserted to achieve one-lung ventilation, and high-frequency jet ventilation (HFJV) was passed through the DLT to provide oxygenation during the anastomosis without interfering with the surgical procedure. The whole procedure was uneventful. We suggest that the double lumen tube could be modified being a simple and safe option for one-lung ventilation in carinal resection and reconstruction under uniportal VATS.

Whether intercostal nerve block can fully realize the prolonged analgesic potential of liposomal bupivacaine remains uncertain. This study aims to evaluate whether liposomal bupivacaine administered via intercostal nerve block confers a long-acting analgesic advantage over bupivacaine hydrochloride and no block within the postoperative 25-72 h window. This is a multicenter, randomized, parallel, three-arm controlled trial planning to enroll 210 patients undergoing elective unilateral video-assisted thoracoscopic surgery. Using center-stratified block randomization (1:1:1), patients will be allocated at the end of surgery to receive an intercostal nerve block with liposomal bupivacaine, bupivacaine hydrochloride, or no block. All patients will follow a standardized general anesthesia and multimodal analgesia protocol. The primary outcome is the area under the curve for pain scores during the postoperative 25-72 h. Other outcomes include pain verbal response scale at predefined time points, cumulative postoperative morphine milligram equivalent consumption, sensory block recovery time, 15-item quality of recovery scale, postoperative nausea and vomiting, postoperative pulmonary complications, length of hospital stay. This study prospectively evaluates the central question of whether liposomal bupivacaine confers a clinically meaningful long-acting analgesic advantage when used in the context of nerve block. By focusing on the area under the curve of pain scores and incorporating patient-centered outcomes such as opioid consumption and quality of recovery, the study aims to generate high-quality, translatable evidence to define the role of liposomal bupivacaine in thoracic surgery. Clinicaltrials.org, NCT07134660.