Minimally invasive thoracic surgery has advanced the treatment of lung cancer since its introduction in the 1990s. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) offer the advantage of smaller incisions without compromising patient outcomes. These techniques have been shown to be safe and effective in standard pulmonary resections (lobectomy and sub-lobar resection) and in complex pulmonary resections (sleeve resection and pneumonectomy). Furthermore, several studies show these techniques enhance patient outcomes from early recovery to improved quality of life (QoL) and excellent oncologic results. The rise of RATS has yielded further operative benefits compared to thoracoscopic surgery. The wristed instruments, neutralization of tremor, dexterity, and magnification allow for more precise and delicate dissection of tissues and vessels. This review summarizes of the advancements in minimally invasive thoracic surgery and the positive impact on patient outcomes.

Background: Lung cancer is the leading cause of cancer-related mortality in the United States, which disproportionately affect racial and ethnic minorities. Disparities in lung cancer screening, diagnosis, treatment, and survival outcomes are due to a complex interplay of socioeconomic factors, structural racism, and limited access to high-quality care. This review aims to examine the underlying causes of these disparities and explore potential mitigation strategies to improve lung cancer care equity. Methods: A review of the literature was conducted, evaluating racial and ethnic disparities in lung cancer care. Disparities in lung cancer screening, genomic testing, surgical and systemic treatment, and survival were explored. Additionally, interventional strategies such as risk-based screening, patient navigation programs, and policy reforms were examined. Results: Racial and ethnic minority patients are diagnosed at younger ages with fewer pack-years yet are less likely to qualify for screening under current guidelines. They receive lower rates of guideline-concordant treatment, including surgery, radiation, chemotherapy, and biomarker testing, and have reduced access to specialty care. Socioeconomic barriers, medical mistrust, and geographic disparities further contribute to these inequities. Targeted interventions, including mobile screening programs, financial assistance initiatives, and culturally competent care, have shown promise in improving lung cancer outcomes. Conclusion: A multi-level approach, incorporating healthcare policy changes, improved screening criteria, and an enhanced community engagement strategy, is essential for achieving equitable lung cancer care, ultimately improving outcomes for racial minority populations.

Hydrogels are hydrophilic 3-dimensional networks characterized by the retention of a large amount of water. Because of their water component, hydrogels are a promising method for targeted drug delivery. The water component, or “free volume”, is a potential vehicle for protein drugs. A particularly intriguing hydrogel is pectin. In addition to a generous free volume, pectin has structural characteristics that facilitate hydrogel binding to the glycocalyceal surface of visceral organs. To test drug function and pectin integrity after loading, we compared pectin films from four distinct plant sources: lemon, potato, soybean, and sugar beet. The pectin films were tested for their micromechanical properties and intrinsic antibacterial activity. Lemon pectin films demonstrated the greatest cohesion at 30% water content. Moreover, modest growth inhibition was observed with lemon pectin (p < 0.05). No effective inhibition was observed with soybean, potato, or sugar beet films (p > 0.05). In contrast, lemon pectin films embedded with carbenicillin, chloramphenicol, or kanamycin demonstrated significant bacterial growth inhibition (p < 0.05). The antibacterial activity was similar when the antibiotics were embedded in inert filter disks or pectin disks (p > 0.05). We conclude that lemon pectin films represent a promising structural platform for antibacterial drug delivery.

Background: Tracheobronchoplasty (TBP) is a definitive anatomic intervention for patients with severe symptomatic expiratory central airway collapse. Although stent evaluations have been described for surgical workup, current literature does not address if improvement during stent evaluation is sustained after TBP. We compared health-related quality of life (HRQOL) and functional status responses after airway stenting to those post-TBP. Methods: A retrospective review was performed in patients with severe expiratory central airway collapse who underwent stent evaluation followed by TBP from January 2004 to December 2019. Baseline, poststent, 3- and 12-month postoperative HRQOL scores, and functional status were analyzed with statistical tests as appropriate. Results: One hundred twenty patients underwent a stent evaluation and TBP. Baseline and stent evaluation measurements were compared with statistically and clinically significant differences in the Cough Quality-of-life Questionnaire (CQLQ) (55 vs. 68, P<0.01), Modified Medical Research Council (mMRC) 0 to 2 (90% vs. 47%, P<0.01), 6-minute walk test (6MWT) (1301 ft vs. 1138 ft, P<0.01). Improvements in the HRQOL and functional status were maintained from stent evaluation to 3 months postoperatively [CQLQ 55 vs. 54, P=0.63; mMRC 0 to 2 (87% vs. 84%), P=0.39; 6MWT 1350 ft vs. 1314 ft, P=0.33], and 12 months postoperatively [CQLQ 54 vs. 54, P=0.91; mMRC 0 to 2 (95% vs. 86%), P=0.74; 6MWT 1409 ft vs. 1328 ft, P=0.13]. The magnitude of change between the data was not significantly different between the stent evaluation, 3-, and 12 months postoperative. Predicted forced expiratory volume in 1-second measurements at baseline, after stent placement, 3 months, and 12 months post-TBP were 74%, 79%, 73%, and 73%, respectively, and not clinically significant. Conclusions: Improvement after stent evaluation and the magnitude of improvement may be predictive of postoperative outcomes up to 1 year after surgery.

PURPOSE: The purpose of this study was to evaluate the complication rates associated with fecal management systems (FMS) and assess compliance with manufacturer guidelines at our institution. DESIGN: Retrospective review. SUBJECTS AND SETTING: Patients with FMS inserted between September 2010 and April 2019 at a tertiary care center located in the Midwestern United States. METHODS: Variables collected included demographics, history of liver cirrhosis, anticoagulation, indications for insertion, complications, and diagnostic or therapeutic interventions. Univariate analysis and Fisher exact test were performed to calculate odds ratio of potential predictive factors. RESULTS: A total of 202 patients were included, with a median age of 63 years. Of these, 3.5% (7 patients) experienced FMS-related complications, all presenting with rectal bleeding; 57% had rectal ulcerations, 71% required transfusions, and 1 patient required operative intervention. Notably, 96% of cases lacked documentation of a digital rectal examination before insertion. The median duration of FMS use was significantly longer in patients with complications (11 days) compared with those without (6 days, P = .05), suggesting that prolonged use may be associated with an increased risk of adverse effects. CONCLUSION: Prolonged use of FMS was associated with an increased risk of complications, and overall adherence to recommended guidelines was poor. Implementing structured documentation and assessment protocols may help improve adherence and promote safer use.