Background/Objectives: Total thymectomy is currently the gold standard operation for treating thymoma. However, recent studies have suggested the potential health consequences of thymus removal in adults, including possible increased autoimmune disease and all-cause mortality. In this context, we assess oncologic outcomes following total vs. partial thymectomy for early-stage thymoma. Methods: We identified patients diagnosed with WHO types A–B3 thymoma between 2010–2021 from a national hospital-based dataset. We excluded patients with stage II or higher disease, open resections and perioperative chemo-/radiation therapy. We stratified patients into total and partial thymectomy cohorts. We used propensity score matching to minimize confounding, Kaplan–Meier analysis to estimate survival, and Cox proportional hazards to identify associations. Results: Of 1598 patients with early-stage thymoma, 495 (31.0%) underwent partial and 1103 (69.0%) total thymectomy. Patients undergoing partial thymectomy were similar in sex (female 53.7% vs. 53.4%; p = 0.914), race (white 74.5% vs. 74.0%; p = 0.921), comorbidities (0 in 77.0% vs. 75.5%; p = 0.742), and tumor size (48.7 mm vs. 50.4 mm; p = 0.455) compared to total thymectomy. There were no differences in 30-day (0.8% vs. 0.6%, p = 0.747) or 90-day mortality (0.8% vs. 0.8%, p > 0.999), which persisted after matching. Moreover, 10-year survival was similar in both unmatched (p = 0.471) and matched cohorts (p = 0.828). Partial thymectomy was not independently associated with survival (aHR = 1.00, p = 0.976). Conclusions: In patients with early-stage thymoma, partial and total thymectomy were associated with similar short- and long-term outcomes. In light of recent attention to the role of the thymus gland, the results add important insights to shared decision-making discussions.

Background: Pneumonia contributes to post-burn morbidity and mortality. Understanding the mechanisms that predispose burn patients to pneumonia is crucial to both stratifying patients at increased risk and developing targeted interventions. Methods: A prospective observational study was conducted with 47 human patients who sustained large burn injuries with serum collected on days 2 and 3 post-burn and assessed for Angiopoietin-1 (Ang-1) and -2 (Ang-2). C57BL/6 mice were subjected to either sham injury or a 12.5% total body surface area (TBSA) scald burn injury, and plasma and lungs were assessed. Results: Patients who developed pneumonia within 30 days of injury had higher serum Ang-2 and Ang-2/1 ratio on post-injury days 2 and 3. Similar to patient findings, we observed an increase in Ang-2 in burn mice compared to sham. Within the lungs of burn mice, we found significant increases in Tyrosine kinase with immunoglobulin and epidermal growth factor homology domains 2 (TIE2) receptor transcript Tek, downstream mediators TNFAIP3 Interacting Protein 2 (Tnip2) and phosphoinositide-3-kinase regulatory subunit 1 (Pik3r1), in addition to endothelial adhesion molecules intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), along with neutrophil infiltration and markers compared to sham. Conclusions: These findings suggest that burn injury increases Angiopoetin-2 and downstream signaling in the lungs, which may contribute to post-burn pulmonary dysfunction. Further studies are necessary to understand if modulating the Ang–TIE2 axis can protect against pneumonia post-burn.

Background: Microvascular free flap reconstruction for complex soft tissue defects relies on vascular perfusion for overall flap survival. Smoking has been linked to complications in postoperative wound healing due to vasoconstriction and weakened immune status. We aim to investigate the impact of smoking on postoperative complications in patients undergoing free flap reconstructive surgery. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, adult patients (≥18 years old) undergoing microvascular free flap surgery (Current Procedural Terminology: 15 756–15 758) from 2010 to 2021 were included. Patients were excluded if they were <18 years old or if they lacked postoperative follow-up data or documented smoking status. Smokers were compared to non-smokers across demographics and postoperative complications. Results: Among 4653 free flap patients, 1202 (25.8%) were smokers. Smokers were more likely to be male, younger, non-diabetic, and have lower body mass index. After multivariable adjustment, smoking status was associated with higher odds of organ/space SSI (OR = 1.653, 95% CI: 1.068–2.558, P = 0.024) and wound disruption (OR = 1.597, 95% CI: 1.092–2.336, P = 0.016). There were no significant differences in rates of superficial or deep incisional SSIs, graft/flap failure, sepsis/septic shock, or venous thromboembolism. Conclusion: Smoking was associated with increased rates of organ/space surgical site infections and wound dehiscence, but not with flap failure in patients undergoing microvascular free flap reconstruction. These findings support the role of preoperative smoking cessation counseling and more nuanced risk stratification focused on wound-related complications rather than flap survival.