Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell). Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively. The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively. The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.

Background: Video-assisted thoracic surgery (VATS)-assisted lobectomy is widely used to treat non-small cell lung carcinoma (NSCLC). There are no reports concerning the comparison between single-port VATS and two-port VATS in treating NSCLC. This study aimed to compare the perioperative and short-term follow-up results between these two methods for treating NSCLC. Methods: A retrospective surgical evaluation of patients undergoing either single-port VATS or two-port VATS for NSCLC between January 2013 and June 2015 was conducted. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. The primary outcome measures were surgical time, blood loss, drainage time, length of hospital stay, postoperative pain score and patient satisfaction score. The data were analyzed statistically with P<0.05 defined as statistically significant. Results: Of the 143 patients who met the inclusion criteria, 66 (46.2%) were operated on using two-port VATS and 77 (53.8%) using single-port VATS. After 1-to-1 PS matching, 63 pairs were selected. Both groups were well balanced for age, gender, body mass index, pulmonary function, preoperative comorbidity, tumor size and tumor type. The single-port VATS group had less blood loss, less postoperative pain, and a higher satisfaction score than those in the two-port VATS group, with statistical significance. Postoperative complications occurred in 2 (2/63, 3.2%) patients in the single-port VATS group and 6 (6/63, 9.5%) patients in the two-port VATS group, not a significant difference. No deaths occurred during the follow-up period. Conclusions: A single-port VATS-assisted lobectomy is suggested to be safe and feasible for treating NSCLC. Compared with two-port VATS, single-port VATS has many advantages, including reduced blood loss, less postoperative pain and a higher satisfaction score.

Cough is a common complication after pulmonary resection. However, the factors associated with cough that develop after pulmonary resection are still controversial. In this study, we used the Simplified Cough Score (SCS) and the Leicester Cough Questionnaire (LCQ) score to investigate potential risk factors for postoperative cough. Between January 2017 and June 2021, we collected the clinical data of 517 patients, the SCS at three days after surgery and the LCQ at two weeks and six weeks after surgery. Then, univariate and multivariate analyses were used to identify the independent risk factors for postoperative cough. The clinical baseline data of the cough group and the non-cough group were similar. However, the cough group had longer operation time and more blood loss. The patients who underwent lobectomy were more likely to develop postoperative cough than the patients who underwent segmentectomy and wedge resection, while the patients who underwent systematic lymph node dissection were more likely to develop postoperative cough than the patients who underwent lymph node sampling and those who did not undergo lymph node resection. When the same lymph node management method was applied, there was no difference in the LCQ scores between the patients who underwent wedge resection, lobectomy and segmentectomy. The lymph node resection method was an independent risk factor for postoperative cough (p < 0.001). Conclusions: Lymph node resection is an independent risk factor for short-term cough after pulmonary resection with video-assisted thoracoscopic surgery, and damage to the vagus nerve and its branches (particularly the pulmonary branches) is a possible cause of short-term cough. The mechanism of postoperative cough remains to be further studied.

Background: Current treatment strategies for advanced non-small cell lung cancer (NSCLC) are highly individualized and subject to ongoing debates. In the era of immunotherapy, surgery assumes a critical role. The aim of this study was to investigate if subsequent surgical intervention, following a favorable response to immunotherapy and chemotherapy, could yield a more favorable prognosis for patients with advanced stage III NSCLC compared to the continuation of immunotherapy and chemotherapy. Methods: We included patients whose tumors exhibited a favorable response (including partial response [PR] and complete response [CR]) to immunotherapy and chemotherapy. These patients were categorized into two groups based on their subsequent treatment plans: surgical and nonsurgical (continuation of maintenance immunotherapy and chemotherapy). The efficacy and long-term prognosis of these groups were compared after matching them in a 1:1 ratio using propensity scores. Results: In total, 186 patients (93 in each group) were included in this study after matching via propensity scores. The 1- and 3-year overall survival (OS) and progression-free survival (PFS) rates were 96.0%, 88.5%, and 93.1%, 80.7% in the surgical group, and 93.2%, 83.1%, and 57.7%, 50.4% in the nonsurgical group, respectively. Patients in the surgical group exhibited significantly superior PFS and OS compared to those in the nonsurgical group (p = 0.025 and p = 0.00086). Univariate and multivariate analyses confirmed Delta BMI, Delta tumor size reduction, tumor response, earlier clinical stage (IIIb vs. IIIa), and surgery as independent protective factor for patient prognosis. We further selected 101 patients with CR (39 in the surgical group and 62 in the nonsurgical group) and found that patients in the surgical group were significantly better in both PFS and OS. Our subgroup analysis in postoperative patients demonstrated that different surgical strategies did not significantly affect the long-term prognosis of patients (PFS and OS) but could impact their perioperative experience. Conclusion: Patients with advanced stage III NSCLC, whose tumors achieved PR and CR after 2-4 cycles of immunotherapy combined with chemotherapy, experience a more promising prognosis with subsequent surgical intervention compared with the continued immunotherapy. Despite encountering formidable obstacles, such as protracted surgical procedures and associated trauma, we must rise to the challenge and unleash the power of surgery after immunotherapy in advanced NSCLC.

Background: Esophageal squamous cell carcinoma (ESCC) is a primary subtype of esophageal cancer (EC), with high morbidity and mortality. This study aimed to identify aberrant expression profiling of non-coding RNAs in ESCC metastasis. Methods: The expression profiling of lncRNA/miRNA/mRNA was measured by RNA-sequencing in primary tumor loci of ESCC patients with metastasis (metastasis group) and without metastasis (primary group). Differentially expressed lncRNA/miRNA/mRNA (DELs/DEMIs/DEMs) were identified in metastasis group. DEMIs-DEMs interaction network, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, Gene Ontology annotation of DEMs were conducted to predict the potential functions of DELs and DEMIs. Quantitative real-time polymerase chain reaction (qRT-PCR) and the Cancer Genome Atlas (TCGA) illumine hiseq data was used to validate the expression level of DELs/DEMIs/DEMs in metastasis and primary group. Results: Respective 43 DELs, 128 DEMIs and 205 DEMs were identified in ESCC metastasis group compared to primary group. DEMIs-DEMs interaction network was constructed, which consisted of 145 nodes and 214 edges involved in 88 DEMIs, furthermore, miR-495-3p, miR-200b-5p and miR-200a-5p had the highest connectivity with DEMs. DEMs were significantly enriched in MAPK signaling pathway, pathways in cancer, and cell adhesion molecules (CAMs). Digestion, cell fate commitment and positive regulation of cell proliferation were three significant enrichment of biological process in GO annotation. AKR1B10 was significantly up-regulated; KRT19 and XIST were significantly down-regulated; SLC7A11 and hsa-miR-224-5p had the up-regulated tendency in metastasis group compared with primary group. Conclusions: Our work might provide useful information for exploring the metastasis mechanism in ESCC and benefit to identification of potential therapeutic targets in ESCC metastasis.

Non-small cell lung cancer (NSCLC) constitutes a substantial global health challenge, with surgical resection serving as a principal therapeutic approach. Nevertheless, the frequency of exploratory thoracotomy without en-bloc resection remains significant, particularly in advanced-stage cases, thereby adversely affecting prognosis. This study aims to predict risk scores for exploratory thoracotomy and analyze postoperative survival in patients with central NSCLC, utilizing CT (computed tomography) imaging subsequent to neoadjuvant therapy. Clinical and radiological data of central NSCLC patients who underwent R0 resection or exploratory thoracotomy from January 2017 to June 2023 were retrospectively reviewed. Independent risk factors for exploratory thoracotomy were identified through a multivariate regression analysis. Subsequently, a nomogram model was developed to assess the risk of exploratory thoracotomy, and was validated through internal and external cohorts. Postoperative disease-free survival (DFS) and overall survival (OS) were analyzed using a Cox regression model. A total of 78 who underwent R0 resection following neoadjuvant therapy and 32 patients who underwent exploratory thoracotomy were included in the analysis. The nomogram model derived from tumor area and vascular deformation both identified as independent risk factors for exploratory thoracotomy, exhibited robust predictive performance. Furthermore, a tumor area of less than 250 mm² at the critical CT slice was associated with better DFS and OS following neoadjuvant therapy and R0 resection. Postoperative immunotherapy has the potential to extend survival in cases where exploratory thoracotomy was performed. CT imaging at the critical slice post-neoadjuvant therapy is crucial for predicting the risk of exploratory thoracotomy and postoperative survival in patients with central NSCLC.