: OBJECTIVES: Evaluating morbidity and survival of patients operated on for a second primary non-small-cell lung cancer (NSCLC). METHODS: Retrospective collection of data from patients operated on for a second NSCLC between 2009 and 2018. RESULTS: Fifty-two patients met the inclusion criteria. At the time of second pulmonary resection, the median time between the 2 surgeries was 25 months (5–44.5 months). Patients’ median age was 65 years (61–68 years). Median tumour size was 16 mm (10–22 mm). Thoracoscopy was used in 75% of cases. The resection was a pneumonectomy (n = 1), bilobectomy (n = 1), lobectomy (n = 15), segmentectomy (n = 32) or wedge resection (n = 3). The length of stay was 7 days (5–9 days). Mortality was null and morbidity was 36.5%, mainly from grade I–II complications according to the Clavien–Dindo classification. The median follow-up was 28 months (13–50 months). The median overall survival was 67 months (95% confidence interval 60.8–73.1 months). Survival at 5 years and specific survival were 71.1% and 67.7%, respectively. CONCLUSIONS: A second surgical resection of either synchronous or metachronous NSCLC has a morbidity that is not superior to the morbidity of the first operation. The new tumour is usually diagnosed at an early stage. An anatomical sublobar resection is most likely the best compromise. It might also be considered for the first operation when there is a suspicious synchronous lesion that may require surgery at a later stage.

Background: Survival rates among non-small cell lung cancer (NSCLC) stage IIIA (N2) patients are generally low and depend on the treatment. Patients and methods: We aimed to identify predictive markers for long term survival in responders and non-responders to chemotherapy, analyzing tumour and non-tumour samples by microarray (n=35) and whole exome sequencing (WES, n=25). Results: WES data showed correlation of overall survival of all patients with rs9905892 in the SLFN12L gene. High frequency of mutations (4/6, 66.7%) was identified in members of SWI/SNF complex in responder patients and in patients that were alive after seven years. Microarray data for immune components showed that VISTA (VSIR) was down-regulated in tumoral tissue. Conclusion: Our research suggests that mutations in SWI/SNF complex associate with long term survival after multimodal treatment, while down-regulation of VISTA might indicate its immunomodulatory role in NSCLC stage III (N2) patients.

Background: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open chest surgery. We have reviewed our data to determine whether the surgical management of these lesions has evolved over the last years. Methods: We retrospectively reviewed the records of patients who were operated on for an ILS by either posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016. Results: Eighteen patients were operated on for a ILS during this period. Before 2011, all resections were performed by thoracotomy (n=6) and after 2011 the approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS presented more frequently on the left side (n=12, 66.7%) than on the right one (n=6, 33.3%) and exclusively in the lower lobes. All the PLT group patients underwent a lobectomy. In the TS group, five patients underwent a sublobar resection (2 segmentectomies S9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45%) had complications versus one patient (14%) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group. Conclusions: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, without opening the chest.

This pilot study evaluated the impact of using a 3D printed model of the patient's bronchovascular lung anatomy on the mental workload and fatigue of surgeons during full thoracoscopic segmentectomy. We performed a feasibility pilot study of a prospective randomized controlled trial with 2 parallel arms. All included patients underwent digital 3D visual reconstruction of their bronchovascular anatomy and were randomized into the following two groups: Digital arm (only a virtual 3D model was available) and Digital + Object arm (both virtual and printed 3D models were available). The primary end-point was the surgeons' mental workload measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score. Between October 28, 2020 and October 05, 2021, we successively investigated all anatomic segmentectomies performed via thoracoscopy in the Thoracic Department of the Montsouris Mutualiste Institute, except for S6 segmentectomies and S4+5 left bi-segmentectomies. We assessed 102 patients for anatomical segmentectomy. Among the, 40 were randomly assigned, and 34 were deemed analysable, with 17 patients included in each arm. Comparison of the two groups, each comprising 17 patients, revealed no statistically significant difference in primary or secondary end-points. The consultation of the visual digital model was significantly less frequent when a 3D printed model was available (6 versus 54 consultations, p = 0.001). Notably, both arms exhibited high NASA-TLX scores, particularly in terms of mental demand, temporal demand, and effort scores. In our pilot study, 3D printed models and digital 3D reconstructions for pre-operative planning had an equivalent effect on thoracoscopic anatomic segmentectomy for experienced surgeons. The originality of this study lies in its focus on the impact of 3D printing of bronchovascular anatomy on surgeons, rather than solely on the surgical procedure.

The field of general surgery offers many different pathologies, cases, and situations for which the general surgeons should be competent in diagnosis as well as treatment and management, including operative intervention. Most situations are complicated by delayed admission to the hospital due to the embarrassment of patient and inability to obtain satisfactory anamnesis. This article reviews the use of computed tomography as a problem‐solving tool in the identification, localization, and presurgical planning for extracting the rectal foreign object.

En bloc resection of lung cancers invading the vertebral column remains a major challenge for both surgeons and patients. At Montsouris Mutualiste Institut, we have a nearly 30-year history of surgically treating such cases. With the development of minimally invasive technology, our technique has also evolved over the time. By introducing thoracoscopy for these complex surgical procedures, we have integrated our recently acquired experience in full thoracoscopy technique for major lung resections, with the extensive historical experience for the treatment of lung cancers invading the spine, of both surgical thoracic and orthopedics teams. This article along with the supplemental video demonstrates our current technique for en bloc resection of lung cancers invading the vertebral column, combining full thoracoscopy approach for lung resection with a posterior approach for spine resection. We highlight our tips and tricks to facilitate the procedure. Compared with traditional thoracotomy, this approach is less invasive and feasible. No severe complications occurred during surgery. Our study demonstrates that combining full thoracoscopy for the lung resection to the direct posterior approach for the spine resection, is a safe and effective technique for lung cancers invading the vertebral column.