BACKGROUND: This study is a retrospective study. This study aims to explore the association between lobectomy in lung cancer patients and subsequent compensatory lung growth (CLG), and to identify factors that may be associated with variations in CLG.
METHODS: 207 lung cancer patients who underwent lobectomy at Yunnan Cancer Hospital between January 2020 and December 2020. All patients had stage IA primary lung cancer and were performed by the same surgical team. And computed tomography examinations were performed before and 1 y postoperatively. Based on computed tomography images, the volume of each lung lobe was measured using computer software and manual, the radiological lung weight was calculated. And multiple linear regressions were used to analyze the factors related to the increase in postoperative lung weight.
RESULTS: One year after lobectomy, the radiological lung weight increased by an average of 112.4 ± 20.8%. Smoking history, number of resected lung segments, preoperative low attenuation volume, intraoperative arterial oxygen partial pressure/fraction of inspired oxygen ratio and postoperative visual analog scale scores at 48 h were significantly associated with postoperative radiological lung weight gain.
CONCLUSIONS: Our results suggest that CLG have occurred after lobectomy in adults. In addition, anesthetists should maintain high arterial oxygen partial pressure/fraction of inspired oxygen ratio during one-lung ventilation and improve acute postoperative pain to benefit CLG.

OBJECTIVE: To investigate the effects of low-dose S-ketamine on marker of myocardial injury (BNP, hs-cTnT and HFABP) after thoracoscopic lobectomy in patients aged 70 to 85.
METHODS: One hundred patients (four cases excluded) aged 70-85 years, with body mass index 18-24 kg·m-2 and American Society of Anesthesiologists physical status II-III, scheduled for elective lobectomy from April 2022 to April 2023, were selected. The patients were divided into two groups by a random number table method, namely, the low-dose S-ketamine combined with GDFT group (group S) and the control group (group C), with 48 cases in each group. In group S, a low dose of S-ketamine (0.2 mg/kg) was given 1 min before intubation, and the maintenance dose was 0.12 mg·kg-1·h-1. Fluid therapy, guided by cardiac index (CI), changes in stroke volume (△SV), and other dynamic indicators, was used for rehydration during the operation. Group C was given the same amount of normal saline (0.2 mg/kg) 1 min before intubation, and the same rehydration therapy was adopted during the operation. The mean arterial pressure (MAP) and heart rate (HR) of the two groups were observed and recorded immediately after entering the operating room (T0), immediately after intubation (T1), immediately after the beginning of one-lung ventilation (OLV) (T2), immediately after the beginning of surgery (T3), immediately after the end of OLV (T4), and at the end of surgery (T5). The intraoperative fluid intake and output and the use of vasoactive drugs were recorded. The plasma levels of heart-type fatty acid-binding protein (HFABP), high-sensitivity troponin T (hs-cTnT), brain natriuretic peptide (BNP), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) were recorded 24 h before operation and 24 and 48 h after operation. Visual analogue scale (VAS) pain scores at rest were recorded at 2 (V1), 6 (V2), 12 (V3), 24 (V4), and 48 h (V5) after operation, and the occurrence of myocardial ischemia during hospitalization was noted.
RESULTS: Compared with group C, MAP was significantly higher at T1-T5 in group S (P < 0.05), and the plasma concentrations of IL-6, IL-8, TNF-α, BNP, hs-cTnT, and HFABP were significantly lower at 24 and 48 h after operation (P < 0.05). The VAS pain scores at 2, 6, 12, 24, and 48 h after operation, the number of effective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions within 48 h after operation were significantly decreased (P < 0.05). Compared with group C, The hospitalization days, and the incidence of postoperative myocardial ischemia in group S were lower (P < 0.05). There were no significant intergroup differences in urine volume, extubation time, the incidence of postoperative atrial fibrillation, bleeding volume, colloid infusion volume, total fluid infusion volume, and the incidence of rescue analgesia.
CONCLUSIONS: Low-dose S-ketamine can reduce the levels of hs-cTnT, HFABP, and BNP in older patients after pulmonary lobectomy, which has a positive effect on preventing myocardial injury.
BACKGROUND: This study was registered on CHICTR (registration No. ChiCTR2300074475). Date of registration: 08/08/2023.

We investigated the clinical therapeutic effects and prognosis of video-assisted thoracoscopic surgery (VATS) in mediastinal lymph node dissection of lung carcinoma. A total of 312 patients were divided into high-risk and conventional risk groups according to the severity of the disease. High-risk group (n=137) received thoracoscope-guided anatomical pulmonary segmentectomy and systematic lymph node dissection as well as conventional risk group (n=175) received thoracoscope-guided pulmonary lobectomy and systematic lymph node dissection. The results revealed that there are significant differences in age, gender, location, lymph node resection methods, and histological classification in the two groups (P<0.05). Moreover, in comparison with the high-risk group, T stage was higher in the conventional group and showed significant statistical significance (P<0.01). The analysis of independent risk factors of the above differences showed that T staging and histological classification showed high-risk coefficients for lymph node dissection. The risk coefficient was increased with patients\' age. The 5-year survival rate, disease-free survival, and postoperative recurrence rate of the patients in the two groups all indicated no obvious statistical differences. Consequently, thoracoscope-guided lymph node dissection could enhance the detection rate of lymph node metastasis. For the adenocarcinoma (AD) patients with T staging greater than T1, lymph node dissection could provide more accurate pathological staging. Anatomical pulmonary segmentectomy combined with systematic lymph node dissection should be applied in the treatment of elderly, high-risk, and advanced stage (prothrombin time (PT) state >2 cm, ≤3 cm) patients with non-small cell lung carcinoma (NSCLC). Taken together,thoracoscope-guided lymph node dissection could improve the detection rate of lymph node metastasis. In this case, the complete resection of lesions could be ensured. Besides, normal pulmonary tissues were preserved to the maximum extent with minimal trauma, safety, fast postoperative recovery, and definite long-term therapeutic effects.

Lobectomy is an effective and well-established therapy for localized lung cancer. This study aimed to assess the lung and lobe change after lobectomy and predict the postoperative lung volume. The study included 135 lung cancer patients from two hospitals who underwent lobectomy (32, right upper lobectomy (RUL); 31, right middle lobectomy (RML); 24, right lower lobectomy (RLL); 26, left upper lobectomy (LUL); 22, left lower lobectomy (LLL)). We initially employ a convolutional neural network model (nnU-Net) for automatically segmenting pulmonary lobes. Subsequently, we assess the volume, effective lung volume (ELV), and attenuation distribution for each lobe as well as the entire lung, before and after lobectomy. Ultimately, we formulate a machine learning model, incorporating linear regression (LR) and multi-layer perceptron (MLP) methods, to predict the postoperative lung volume. Due to the physiological compensation, the decreased TLV is about 10.73%, 8.12%, 13.46%, 11.47%, and 12.03% for the RUL, RML, RLL, LUL, and LLL, respectively. The attenuation distribution in each lobe changed little for all types of lobectomy. LR and MLP models achieved a mean absolute percentage error of 9.8% and 14.2%, respectively. Radiological findings and a predictive model of postoperative lung volume might help plan the lobectomy and improve the prognosis.

The association between exposure to ambient fine particulate matter with an aerodynamic diameter of ≤ 2.5 μm (PM2.5) and short- and medium-term lung function recovery (LFR) in patients undergoing lobectomy remains uncertain. This study investigated the associations between PM2.5 concentrations and LFR in adult patients (n = 526) who underwent video-assisted thoracoscopic (VATS) lobectomy in Guangzhou, China between January 2018 and June 2021. All patients underwent at least two spirometry tests. Environmental PM2.5 concentrations in the same period were collected from the nearest monitoring station. A multiple linear regression (MLR) model was employed to investigate the associations between changes in PM2.5 concentrations and LFR in patients who underwent lobectomy after adjusting for potential confounders. We assessed short- and medium-term LFR in patients who underwent lobectomy. The three- and 6-month average PM2.5 concentrations in each patient\'s residential area were divided into regional mild pollution (PM2.5 <25 μg/m3), moderate pollution (25 μg/m3 ≤ PM2.5 <35 μg/m3), and severe pollution (35 μg/m3 ≤ PM2.5) periods. The MLR model confirmed that PM2.5 was an independent risk factor affecting short-term forced lung capacity (FVC), forced expiratory volume in 1 s (FEV1), and maximum expiratory flow at 50% vital capacity (MEF50) recovery (adjusted P = 0.041, 0.014, 0.016, respectively). The MLR model confirmed that PM2.5 was an independent risk factor affecting medium-term MEF50 recovery (adjusted P = 0.046). Compared with the moderate and severe pollution periods, the short- and medium-term LFR (FVC, FEV1, MEF50) of patients in the mild pollution period were faster and better (P < 0.001, P < 0.001, P < 0.001, P = 0.048, P = 0.010, P = 0.013, respectively). Thus, exposure to high PM2.5 levels was associated with significantly reduced speed and degree of short- and medium-term LFR in patients who underwent lobectomy.

OBJECTIVE: We analyzed the outcomes of patients suffering acute ischemic stroke (AIS) with large vessel occlusion (LVO) soon after pulmonary lobectomy.
METHODS: We retrospectively reviewed the clinical records of patients who underwent pulmonary lobectomy to treat primary lung cancer. We retrieved clinical characteristics and the incidence of AIS with LVO. The clinical courses of patients who experienced AIS were reviewed.
RESULTS: In 10 (0.3%) of 3406 patients, AIS with LVO developed soon (within 3 days) after pulmonary lobectomy. The lung resection site was on the left in eight patients (80%). All patients underwent thrombectomy and achieved complete recanalization (Thrombolysis in Cerebral Infarction [TICI] 3). The average time between symptom onset and recanalization was 165.5 min. Nine (90%) patients exhibited favorable outcomes (modified Rankin scale [mRS] score ≤ 2) at the 3-month follow-up.
CONCLUSIONS: Endovascular therapy effectively treats AIS with LVO that develops after lung surgery, and direct aspiration is a promising strategy. A large, multicenter study is warranted to further confirm these findings.

Lobectomy is a curative treatment for localized lung cancer. The study aims to construct an automatic pipeline for segmenting pulmonary lobes before and after lobectomy from CT images.
Six datasets (D1 to D6) of 865 CT scans were collected from two hospitals and public resources. Four nnU-Net-based segmentation models were trained. A lobectomy classification was proposed to automatically recognize the category of the input CT images: before lobectomy or one of five types after lobectomy. Finally, the lobe segmentation before and after lobectomy was realized by integrating the four models and lobectomy classification. The dice similarity coefficient (DSC), 95% Hausdorff distance (HD95) and average symmetric surface distance (ASSD) were used to evaluate the segmentations.
The pre-operative model achieved an average DSC of 0.964, 0.929, 0.934, and 0.891 in the four datasets. In D1 and D2, the average HD95 was 4.18 and 7.74 mm and the average ASSD was 0.86 and 1.32 mm, respectively. The lobectomy classification achieved an accuracy of 100%. After lobectomy, an average DSC of 0.973 and 0.936, an average HD95 of 2.70 and 6.92 mm, an average ASSD of 0.57 and 1.78 mm were obtained in D1 and D2, respectively. The postoperative segmentation pipeline outperformed other counterparts and training strategies.
The proposed pipeline can automatically segment pulmonary lobes before and after lobectomy from CT images and be applied to manage patients with lung cancer after lobectomy.

BACKGROUND: In order to analyze the feasibility of pulmonary lobectomy for non-small cell lung cancer (NSCLC) in early period after percutaneous coronary intervention (PCI), the current study was designed to compare perioperative characteristics and prognostic performance of patients with pulmonary lobectomy within 3 months or 3 months later after PCI.
METHODS: This study enrolled 349 patients simultaneously with NSCLC and coronary stenosis. There were 198 and 151 patients with pulmonary lobectomy within 3 months or 3 months later after PCI, respectively.
RESULTS: Age of all patients was 62 [53-75] years. There was no difference in demographic characteristics, medical histories, cancer locations and stent numbers between two groups (P>0.05 for all). Operation time, blood loss and hospital stay after pulmonary lobectomy had no difference between two groups (P>0.05 for all). Compared with those with pulmonary lobectomy 3 months later after PCI, survival rate during 5 years after pulmonary lobectomy was significantly higher in patients with pulmonary lobectomy within 3 months after PCI (P<0.05 for all).
CONCLUSIONS: Patients with pulmonary lobectomy within 3 months after PCI had similar perioperative characteristics and better prognostic performance, as compared to those with pulmonary lobectomy 3 months later after PCI. The current study could provide valuable information in patients simultaneously with NSCLC and coronary stenosis to decide the timing of pulmonary lobectomy, and it might be feasible to perform pulmonary lobectomy in early period after PCI.

OBJECTIVE: To explore the effect of a single preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) and erector spinae plane block (ESPB) for perioperative analgesia in thoracoscopic pulmonary lobectomy.
METHODS: Seventy-two patients aged 40-70 years who underwent thoracoscopic pulmonary lobectomy under general anesthesia were enrolled and randomly divided into the control group (Group C), the TPVB group (Group T) and the ESPB group (Group E). The primary observation indicators included the visual analogue scale (VAS) at 1, 6, 12, 24, and 48 h postoperatively at rest and with a cough. The secondary observation indicators included the intraoperative sufentanil consumption, anesthesia awakening time and extubation time, the sufentanil consumption in the analgesic pump, and flurbiprofen ester consumption for remedial analgesia within 48 h after surgery and the incidence of postoperative adverse events.
RESULTS: The intraoperative sufentanil consumption, anesthesia awakening time, and extubation time were lower in groups T and E than those in group C (p < 0.05). Patients in group T had lower VAS scores at rest and with a cough at 1, 6, and 12 h postoperatively than in group C at the same time points (p < 0.05). The VAS scores at rest at 1 and 6 h postoperatively and coughing status at 1, 6, and 12 h postoperatively were lower in group E than in group C at the same time points (p < 0.05).
CONCLUSIONS: The ultrasound-guided preoperative single TPVB and ESPB for thoracoscopic pulmonary lobectomy could both reduce the postoperative pain VAS score and reduce the dose of perioperative sufentanil and postoperative remedial analgesics.

A tracheal bronchus is a rare congenital anomaly, suggesting abnormal bronchial development. The prevalence of tracheal bronchus in children who undergo bronchoscopy is estimated to be between 0.2% and 3%. When associated with recurrent infection, lobes of the lung must be removed to avoid further lung injury. In such cases, perioperative one-lung ventilation and airway management remain a huge challenge for anaesthesiologists. The case of this rare airway anatomic abnormality in a paediatric patient with two bronchial openings into the right upper lobe, and with a history of recurrent pneumonia, is reported. In addition to a normal opening, a distinct opening in the upper lobe of the right lung was observed, that originated directly from the trachea, superior to the carina. The entire right lung was deflated by left-lung ventilation using a single lumen tracheal tube, and the patient underwent right upper lobe resection. No anaesthesia complications were observed during recovery. In this case, timely identification of the tracheal bronchus and successful collapse of the right lung were key points in the anaesthesia management of this patient.