Background: Inflammation plays a crucial role in lung cancer recurrence after surgery. This study aims to investigate the relationship between lung cancer recurrence and perioperative inflammatory status, assessed in both blood and bronchoalveolar lavage (BAL) fluid. Methods: We conducted a retrospective cohort study analyzing clinical variables, blood cytokine levels, and BAL fluid from lung cancer patients who underwent surgery. Logistic regression models were employed to predict recurrence. Results: Among 93 patients, 41.9% experienced recurrence within ten years. The logistic regression model identified vital status, tumor stage, and type of surgery as significant predictors of recurrence. Postoperatively, pro-inflammatory cytokines were elevated, particularly in patients who experienced recurrence. Higher levels of TNF-α in BAL fluid and increased IL-6 in blood correlated with recurrence. Additionally, metalloproteinases in BAL fluid exhibited distinct associations: MMP-2 was identified as a risk factor, whereas MMP-9 appeared to have a protective role. A multivariate model integrating clinical variables and inflammatory biomarkers significantly improved predictive accuracy (p < 0.0001). Discussion: Combining inflammatory biomarkers with clinical variables enhances the prediction of lung cancer recurrence after surgery. Understanding the dynamics of these biomarkers may facilitate early detection and enable more personalized treatment strategies.

Background: Cerebral desaturation during one-lung ventilation (OLV) in thoracic surgery has been associated with postoperative cognitive dysfunction (POCD). While the adverse effects of low intraoperative regional cerebral oxygen saturation (rScO₂) are well documented, the potential clinical value of maintaining supranormal rScO₂ levels has not been thoroughly studied. Methods: We conducted a retrospective observational study based on a previously collected cohort from a tertiary university hospital. Adult patients undergoing elective thoracic surgery between January 2019 and December 2022 were included, provided they received lidocaine either intravenously or via a paravertebral block as part of a standardized anesthetic protocol. Patients were divided into the following two groups based on their mean INVOS values 30 min into OLV: those with rScO₂ ≥75% (H-INVOS group) and <75% (L-INVOS group). Intraoperative physiological variables, inflammatory biomarkers, cognitive function via the Mini-Mental State Examination, and postoperative outcomes were analyzed. Results: The H-INVOS group exhibited significantly higher preoperative lung function, higher PaO₂ and PaCO₂ values during OLV, and higher hemoglobin concentrations across all timepoints. They also demonstrated better preservation of cognitive function, lower IL-18 expression at 24 h postoperatively, and shorter hospital stays. There were no statistically significant differences in intraoperative hemodynamics or ventilatory mechanics.

Background/Objectives: Lidocaine has demonstrated immunomodulatory properties and promising antitumor effects in experimental models, but its impact on long-term outcomes following oncologic surgery remains unclear. This study aimed to compare the impact of intraoperative lidocaine versus remifentanil on long-term cancer outcomes after primary lung cancer surgery. Methods: This is a post hoc analysis of a randomized controlled trial (NCT03905837, EudraCT 2016-004271-52). From 154 patients who underwent elective lung resection via video-assisted thoracoscopic surgery (VATS) between January 2019 and June 2021 and were randomized to receive intraoperative lidocaine (intravenous or paravertebral) or remifentanil, we analyzed data from patients with confirmed primary lung cancer in the surgery specimen. Overall survival (OS) and disease-free survival (DFS) were assessed through May 2025. Survival outcomes were analyzed using Kaplan–Meier curves and log-rank tests. A multivariate Cox proportional hazards model was used to adjust for potential confounders. Results: Among the 97 patients with primary lung cancer finally included in the analysis, those in the lidocaine group exhibited improved OS compared with those who received intravenous remifentanil (log-rank p = 0.022). This association remained significant in the multivariate Cox regression analysis (HR 2.59, 95% CI 1.13–5.96, p = 0.025). No significant differences were observed in DFS overall (log-rank p = 0.283) or in DFS limited to recurrences of cancers present at the time of surgery, either the resected primary tumor or a prior malignancy (log-rank p = 0.080). Conclusions: In this post hoc analysis, lidocaine administration during oncologic lung resection was associated with improved OS in primary lung cancer patients. No differences in DFS were observed between groups; however, a non-significant trend toward improved DFS in lidocaine patients was noted when focusing on recurrences of cancers present at the time of surgery. Further investigation in larger prospective studies is warranted.