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Emerging Technologies in Thoracic Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (31 January 2026) | Viewed by 2710

Special Issue Editors


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Guest Editor
Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Interests: lung cancer; molecular biology; artificial intelligence; precision therapy; mediastinum; pleura

E-Mail Website
Guest Editor
Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Interests: lung cancer; molecular biology; artificial intelligence; precision therapy; mediastinum; pleura

Special Issue Information

Dear Colleagues,

The management of lung cancer is becoming increasingly complex, driven by a growing understanding of molecular biology and emerging therapies associated with it. The analysis of the biomolecular pattern in tumor tissue has already partially revolutionized clinical practice, and it is partly due to this development and the knowledge of the tumor microenvironment that new treatments have been developed in recent years for locally advanced stages and, more recently, even for earlier stages.

The complexity of decision-making algorithms seems set to increase in the coming years, owing as well to the advent of clinical practices based on information derived not from tissue but from the blood of patients with lung cancer ("liquid biopsy").

In this new scenario, the advent of artificial intelligence also plays a key role, as it will be able to (as clearly demonstrated in other fields) manage this vast amount of information ("big data") to generate prediction models for diagnosis and personalized treatment ("precision therapy").

Furthermore, it should also be noted that the surgical scenario is evolving too with the widespread application of minimally invasive surgery, such as RATS and U-VATS.

This Special Issue aims to collect new evidence on the safety, efficacy and reproducibility of minimally invasive techniques, such as Uniportal-VATS and RATS, in lung, mediastinal and esophageal diseases. It also aims to explore the results of new oncological integrated strategies for diagnosis and treatment predicated on the progress made in the field of molecular biology and artificial intelligence.

Original research articles and reviews are welcome.

Research areas may include (but are not limited to) the following:

  • Minimally invasive thoracic surgery (VATS and RATS);
  • Current evidence on NSCLC pathogenesis and modern strategies for integrated treatment and future perspectives;
  • Molecular biology advances in lung cancer treatment (i.e., the role of liquid biopsy);
  • New insights in thoracic surgery with the application of artificial intelligence.

I look forward to receiving your contributions.

Prof. Dr. Filippo Lococo
Dr. Carolina Sassorossi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung cancer
  • molecular biology
  • liquid biopsy
  • immunotherapy
  • precision surgery
  • minimally invasive surgery
  • new technologies
  • artificial intelligence

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Published Papers (2 papers)

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Research

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17 pages, 2146 KB  
Article
Validation of the 9th Edition of the TNM Classification in Patients with NSCLC and Lymph Node Involvement: A Retrospective, Multicentric, Observational Study
by Carolina Sassorossi, Marco Chiappetta, Filippo Lococo, Gloria Santoro, Pierluigi Novellis, Giulia Veronesi, Riccardo Di Fonzo, Filippo Tommaso Gallina, Francesco Facciolo, Vittorio Aprile, Alessandra Lenzini, Marco Lucchi, Sara Ricciardi, Giuseppe Cardillo, Andrea Tornese, Ludovic Fournel, Marco Alifano and Stefano Margaritora
Cancers 2026, 18(4), 702; https://doi.org/10.3390/cancers18040702 - 20 Feb 2026
Viewed by 750
Abstract
Background: The ninth edition of the TNM classification introduced refinements in nodal staging, subdividing mediastinal N2 disease into N2a (single-station) and N2b (multi-station) involvement, alongside several stage group adjustments. The aim of this study is to validate the new TNM in patients with [...] Read more.
Background: The ninth edition of the TNM classification introduced refinements in nodal staging, subdividing mediastinal N2 disease into N2a (single-station) and N2b (multi-station) involvement, alongside several stage group adjustments. The aim of this study is to validate the new TNM in patients with nodal involvement who underwent surgery. Methods: This is a multicentric, retrospective study including NSCLC patients with pathological N1 or N2 involvement who underwent anatomical pulmonary resection between January 2020 and December 2023. Clinical, surgical, and pathological data were collected, including tumor characteristics, lymphadenectomy details, and adjuvant therapy. Patients were reclassified according to the ninth TNM groups: stage IIB, including T1N1, T2N1, and T3N0; IIIA, including T1N2b, T2-3N2a, T3N1, T4N0, and T4N1; and IIIB, including T2-3N2b, T4N2a, and T4N2b. Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan–Meier curves. Results: The final analysis involved 291 patients. The three- and five-year OS rates were 82% and 71% for stage IIB, and 75% and 58% for stage IIIA, respectively. At stage IIB, a significant difference was found only for DFS comparing T2N1 and T1N2a, whereas stage IIIA showed no significant differences in either OS or DFS, confirming its prognostic homogeneity. Conversely, stage IIIB exhibited significant heterogeneity in survival (OS p = 0.031; DFS p < 0.0001), with T4N2b subgroups showing the worst outcomes compared to T2-3N2b and T4N2a. Conclusions: Our validation of the ninth edition of lung cancer staging shows improved prognostic granularity: IIB shows non-homogeneous DFS, IIIA is homogeneous, and IIIB shows major OS/DFS substage differences, warranting analyses with larger samples for refined stratification. Full article
(This article belongs to the Special Issue Emerging Technologies in Thoracic Surgery)
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Review

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13 pages, 428 KB  
Review
Photon-Counting Computed Tomography in Thoracic Surgery: A Narrative Review of Current and Future Applications
by Giuseppe Mangiameli, Debora Brascia, Filippo Lococo and Giuseppe Marulli
Cancers 2025, 17(22), 3656; https://doi.org/10.3390/cancers17223656 - 14 Nov 2025
Cited by 1 | Viewed by 1499
Abstract
Photon-counting computed tomography (PCCT) introduces a new era in thoracic imaging by offering ultra-high spatial resolution, reduced noise, spectral imaging capabilities, and lower radiation dose compared to conventional CT. These features are particularly relevant in thoracic surgery, where precise anatomical and functional assessment [...] Read more.
Photon-counting computed tomography (PCCT) introduces a new era in thoracic imaging by offering ultra-high spatial resolution, reduced noise, spectral imaging capabilities, and lower radiation dose compared to conventional CT. These features are particularly relevant in thoracic surgery, where precise anatomical and functional assessment is essential throughout the perioperative period. This narrative review outlines the clinical potential of PCCT in surgical planning, intra- and postoperative evaluation, and follow-up of both oncologic and non-oncologic thoracic conditions. PCCT enables accurate bronchovascular mapping and iodine-based perfusion imaging, supporting sublobar resection planning and risk stratification in patients with complex anatomy or reduced lung function. Postoperatively, it enhances detection of subtle complications—such as air leaks or hematomas—and improves image quality near metallic implants through advanced artifact reduction techniques. The ability to combine high-resolution imaging with functional data allows for comprehensive evaluation in a single scan and may aid in differentiating fibrosis from local recurrence. Despite its promises, PCCT adoption is currently limited by high cost, restricted availability, and the need for training and system integration. Furthermore, prospective clinical studies are still needed to determine its impact on surgical outcomes. As technological and infrastructural challenges are addressed, PCCT may become a valuable component of image-guided thoracic surgery, contributing to safer, more personalized care. Full article
(This article belongs to the Special Issue Emerging Technologies in Thoracic Surgery)
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