Objectives: The choice of therapeutic intervention for postoperative air leak varies between institutions. We aimed to identify the optimal timing and patient criteria for therapeutic intervention in cases of postoperative air leaks after lung resection. Methods: This study utilized data from a prospective multicenter observational study conducted in 2019. Among the 2187 cases in the database, 420 cases with air leaks on postoperative day 1 were identified. The intervention group underwent therapeutic interventions, such as pleurodesis or surgery, while the observation group was monitored without intervention. A comparison between the intervention group and the observation group were analyzed using the cumulative distribution and hazard functions. Results: Forty-six patients (11.0%) were included in the intervention group. The multivariate analysis revealed that low body mass index (p = 0.019), partial resection (p = 0.010), intraoperative use of fibrin glue (p = 0.008), severe air leak on postoperative day 1 (p < 0.001), and high forced expiratory volume in 1 s (p = 0.021) were significant predictors of the requirement for intervention. The proportion of patients with persistent air leak in the observation group was 20% on postoperative day 5 and 94% on postoperative day 7. The hazard of air leak cessation peaked from postoperative day 3 to postoperative day 7. Conclusions: This research contributes valuable insights into predicting therapeutic interventions for postoperative air leaks and identifies scenarios where spontaneous cessation is probable. A validation through prospective studies is warranted to affirm these findings.

A partial anomalous pulmonary venous connection is a rare congenital defect in which blood from the pulmonary vein is returned to the right atrium. Asymptomatic patients with a partial anomalous pulmonary venous connection with a small left-to-right shunt do not require surgical treatment. If such patients require a major lung resection, the surgical procedure could precipitate fetal right heart failure if the anomalous venous connection remains uncorrected. A 59-year-old man was found to have an abnormal shadow on chest roentgenogram. Chest computed tomography imaging showed a mass in the right upper lobe. At the same time, we incidentally found an anomalous vessel. We diagnosed the abnormality as a partial anomalous pulmonary venous connection. Because the mass may have been lung cancer, a right upper lobectomy was performed using video-assisted thoracoscopic surgery. The right upper lobe vein drained into the superior vena cava. The anomaly was not corrected and the surgery was successful. His postoperative course was uneventful without cardiac failure. Before performing a major lung resection, surgeons should be aware of this rare anomaly and carefully interpret clinical images of all pulmonary veins.

ObjectivesThe Japanese Joint Committee for Lung Cancer Registry conducted a nationwide, prospective registry of newly diagnosed pleural mesothelioma cases. We aimed to develop a treatment-independent risk score that stratifies prognosis within each treatment modality and identifies overlapping risk strata across different treatment strategies in real-world practice.MethodsCandidate prognostic factors previously reported in the literature were measured in 346 registered cases. Variables with a high proportion of missing data were excluded. For the 281 cases with complete data (110 surgical cases, 136 non-surgical treatment cases, 35 best supportive care cases), prognostic factors were selected using a forward stepwise selection method. A risk score was then calculated based on the final multivariable model.ResultsC-reactive protein, albumin, histology, N status (according to the 8th edition of the TNM staging system for pleural mesothelioma), tumor shape, and smoking status were identified as independent prognostic factors, regardless of whether treatment information was included. The risk score, reflecting individual mortality risk, showed distinct distributions depending on treatment type. When patients were stratified into high- and low-risk groups using the median risk score within each treatment category, the high-risk group consistently exhibited significantly poorer survival. Further, among patients eligible for both surgical and non-surgical treatment according to risk score, surgery was associated with longer survival within comparable risk strata.ConclusionsThis risk score offers a treatment-independent prognostic indicator that can be used to estimate survival across treatment options and guide therapeutic decision-making in patients with pleural mesothelioma.