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Innovations in Thoracic Surgery and Disease Management: Integrating Genomics, Technology, and Multidisciplinary Care

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 28 May 2026 | Viewed by 3322

Special Issue Editors

Dr. Marco Scarci

E-Mail Website
Guest Editor
1. Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
2. National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
Interests: uniportal video-assisted thoracic surgery; thoracic oncology; chest wall deformities; thoracic trauma; surgical education and simulation
Special Issues, Collections and Topics in MDPI journals
Dr. Savvas Lampridis

E-Mail Website
Guest Editor
1. Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
2. National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
Interests: robotic surgery; thoracic oncology; thoracic trauma; translational cardiovascular medicine; surgical education and simulation; health policy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thoracic surgery and disease management are being transformed by advances in genomics, technology, and multidisciplinary care. This Special Issue will explore the breakthroughs that will improve patient outcomes across the spectrum of thoracic diseases.

From lung cancer to complex airway disorders, thoracic diseases require precision and adaptability. Genomic integration enables personalized therapies through molecular profiling and targeted interventions, transforming treatment selection and prognostication. Technological innovations, including robotic surgery, advanced imaging modalities, and artificial intelligence applications, enhance precision while minimizing invasiveness. Complementing these tools, collaboration among surgeons, oncologists, radiologists, and pulmonologists ensures holistic patient-centered care.

We invite original research, reviews, and case studies that demonstrate the clinical impact of these integrative approaches. Join us in shaping a future where innovation elevates excellence in thoracic care.

Dr. Marco Scarci
Dr. Savvas Lampridis
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 short 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. Journal of Clinical Medicine 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 2600 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

  • thoracic surgery
  • thoracic disease
  • genomic medicine
  • artificial intelligence
  • advanced imaging
  • multidisciplinary care
  • minimally invasive surgery
  • robotic surgery
  • precision medicine

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Published Papers (5 papers)

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Research

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15 pages, 617 KB  
Article
Surgical Aspects of Treatment of the Lung Cancer Found in Low-Dose CT-Based Screenings
by Małgorzata E. Wojtyś, Janusz Wójcik, Arkadiusz Waloryszak, Norbert Wójcik, Piotr Lisowski and Tomasz Grodzki
J. Clin. Med. 2026, 15(3), 947; https://doi.org/10.3390/jcm15030947 - 24 Jan 2026
Viewed by 460
Abstract
Background: Lung cancer is the leading cause of cancer-related death worldwide. Screening with low-dose computed tomography (LDCT) enables early detection of low-stage non-small cell lung cancer (NSCLC), increasing the chances of curative surgery. The aim of the present study was to analyze selected [...] Read more.
Background: Lung cancer is the leading cause of cancer-related death worldwide. Screening with low-dose computed tomography (LDCT) enables early detection of low-stage non-small cell lung cancer (NSCLC), increasing the chances of curative surgery. The aim of the present study was to analyze selected surgical aspects of treatment among patients diagnosed with NSCLC through LDCT-based screening in Szczecin, the first program of this kind in Poland. Methods: A group of 52 patients who were screened and operated on was compared with patients diagnosed and operated on outside the screening program during the same time period and a group of patients diagnosed and operated on prior to the screening program being implemented. Results: The screened population demonstrated a significantly higher frequency of stage IA cancer diagnosis, smaller tumor volume, more lobectomies, and fewer pneumonectomies compared with the other two groups. In addition, the waiting time for surgery was shorter, the duration of the procedure longer, and the length of hospitalization was reduced among the screened patients. No significant differences were observed in postoperative mortality or perioperative complications. Adenocarcinoma occurred significantly more often in the screened population than in the other groups, and tumors were more frequently classified as grade G2. A significant correlation was found between the need for blood transfusion and the occurrence of perioperative complications. Conclusions: The implementation of an LDCT-based screening program for lung cancer has a significant impact on the workload and case profile of thoracic surgery departments. Several aspects of surgical treatment differ significantly between patients diagnosed through screening and patients diagnosed outside of the program. Full article
(This article belongs to the Special Issue Innovations in Thoracic Surgery and Disease Management: Integrating Genomics, Technology, and Multidisciplinary Care)
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19 pages, 933 KB  
Article
Scintigraphic Assessment of Lung Perfusion and Ventilation in Patients After Pneumonectomy
by Karina Witkiewicz, Małgorzata Edyta Wojtyś, Norbert Wójcik, Krzysztof Safranow, Jarosław Pieróg, Jacek Szulc, Tadeusz Sulikowski, Konrad Jarosz, Tomasz Grodzki and Janusz Wójcik
J. Clin. Med. 2025, 14(24), 8849; https://doi.org/10.3390/jcm14248849 - 14 Dec 2025
Viewed by 609
Abstract
Background/Objectives: The physiological ventilation–perfusion ratio (V/Q) in the upper pulmonary field is >3 and in the lower pulmonary field it is <1 due to the effect of gravity when the body is in an upright position. Pneumonectomy leads to significant changes in ventilation [...] Read more.
Background/Objectives: The physiological ventilation–perfusion ratio (V/Q) in the upper pulmonary field is >3 and in the lower pulmonary field it is <1 due to the effect of gravity when the body is in an upright position. Pneumonectomy leads to significant changes in ventilation and perfusion conditions. The aim of this study was to evaluate perfusion and ventilation after pneumonectomy complicated by pleural empyema, including the relationship between surgical outcomes, sex, and time from pneumonectomy. Methods: The study group included 30 patients (25 men, 5 women) who underwent pneumonectomy complicated by pleural empyema. Lung function was assessed using ventilation–perfusion scintigraphy. Twenty-one patients were assessed within 5 years after pneumonectomy and nine patients >5 years after pneumonectomy. Results: Average flow was 21.1% in the upper field, 47.8% in the middle field, and 30.35% in the lower field. The mean perfusion value was significantly higher in the lower field of the right lung than in the lower field of the left lung (33.35 vs. 28.05, p = 0.001). Average ventilation was 17.21% in the upper field, 46.73% in the middle field, and 34.28% in the lower field. The mean V/Q in the upper field was in the range of 0.81–0.87, but it reached approximately 1 (0.96–1) in the middle field and exceeded 1 (1.05–1.25) in the lower field. Conclusions: Pneumonectomy led to increased perfusion in the upper pulmonary field and increased ventilation in the lower pulmonary field compared to the literature for patients with the two lungs (the two-lung system), with a reversal of the V/Q between the upper and lower field. Full article
(This article belongs to the Special Issue Innovations in Thoracic Surgery and Disease Management: Integrating Genomics, Technology, and Multidisciplinary Care)
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Review

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25 pages, 1492 KB  
Review
The Role of CEUS in the Diagnosis and Follow-Up of Pleuropulmonary Diseases and Interventional Procedures
by Andrea Boccatonda, Alice Brighenti, Daniel Piamonti, Giulia Bandini, Giulia Fiorini, Luigi Vetrugno, Giampietro Marchetti, Esterita Accogli, Carla Serra and Damiano D’Ardes
J. Clin. Med. 2026, 15(6), 2292; https://doi.org/10.3390/jcm15062292 - 17 Mar 2026
Viewed by 570
Abstract
Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient [...] Read more.
Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient surveillance. Methods: This review summarizes the current evidence on the use of CEUS in major pleuropulmonary disorders, including pneumonia, pleural effusion, pulmonary embolism, neoplasms, and COVID-19-related lung injury. The most relevant clinical studies and meta-analyses were analyzed, focusing on CEUS parameters, diagnostic performance, and integration with other imaging techniques. Results: CEUS enables the differentiation between inflammatory, ischemic, and malignant lesions through qualitative and quantitative analyses of enhancement patterns. Early and homogeneous enhancement is typical of inflammatory or infectious processes, whereas heterogeneous or delayed enhancement with early washout strongly suggests malignancy or ischemia. In pneumonia and pleural infections, CEUS identifies non-perfused or necrotic areas, guiding drainage and evaluating therapeutic responses. In pulmonary embolism, it reveals avascular consolidations corresponding to infarction, even when CT angiography is inconclusive. For peripheral lung tumors, CEUS assesses angiogenesis and vascular supply, correlating perfusion parameters with histopathology, and improving biopsy targeting. Furthermore, in COVID-19 pneumonia, CEUS can detect microvascular alterations related to thrombosis and fibrosis. Conclusions: CEUS is a safe, noninvasive, and radiation-free technique that provides unique real-time information on pulmonary perfusion. Its integration with conventional ultrasound enhances diagnostic precision, optimizes interventional guidance, and allows for dynamic monitoring of treatment response. Future developments in quantitative analysis, artificial intelligence, and targeted contrast agents are expected to further expand CEUS clinical applications in pleuropulmonary imaging. Full article
(This article belongs to the Special Issue Innovations in Thoracic Surgery and Disease Management: Integrating Genomics, Technology, and Multidisciplinary Care)
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21 pages, 1236 KB  
Review
Optimizing Lymph Node Staging in Non-Small Cell Lung Cancer Surgery: Evidence, Guidelines, and Quality Improvement Strategies
by Dimitrios E. Magouliotis, Vasiliki Androutsopoulou, Ugo Cioffi, Fabrizio Minervini, Noah Sicouri, Andrew Xanthopoulos and Marco Scarci
J. Clin. Med. 2026, 15(2), 831; https://doi.org/10.3390/jcm15020831 - 20 Jan 2026
Viewed by 707
Abstract
Lymph node evaluation is a central determinant of oncologic quality in the surgical management of non-small-cell lung cancer (NSCLC). Accurate assessment of hilar and mediastinal lymph nodes underpins pathologic staging, informs postoperative treatment decisions, and remains essential for prognostic stratification and assessment of [...] Read more.
Lymph node evaluation is a central determinant of oncologic quality in the surgical management of non-small-cell lung cancer (NSCLC). Accurate assessment of hilar and mediastinal lymph nodes underpins pathologic staging, informs postoperative treatment decisions, and remains essential for prognostic stratification and assessment of resection completeness. Although international guidelines provide clear recommendations, real-world data consistently demonstrate substantial variability in lymph node staging practices, with inadequate evaluation frequently observed across institutions and surgical settings. Insufficient nodal assessment, manifested as the omission of mediastinal staging, limited station sampling, or low lymph node yield, is associated with reduced nodal upstaging, inappropriate omission of adjuvant therapy, higher recurrence rates, and inferior long-term survival. Contemporary guidance from major societies, including the National Comprehensive Cancer Network, European Society of Thoracic Surgeons, International Association for the Study of Lung Cancer, and the Commission on Cancer, has increasingly converged on a station-based definition of adequacy, emphasizing systematic evaluation of both N1 and N2 nodal stations rather than reliance on absolute node counts alone. In parallel, preoperative mediastinal staging algorithms have evolved toward routine use of endobronchial and esophageal ultrasound as first-line invasive modalities, reserving surgical mediastinoscopy for selected high-risk or inconclusive cases. Evidence from randomized trials, population-level databases, and meta-analyses indicates that thorough nodal assessment improves staging accuracy and survival, while recent data support the selective use of lobe-specific or tailored lymphadenectomy in carefully staged, low-risk early disease. Finally, emerging quality improvement interventions, including standardized specimen handling, operative checklists, and multidisciplinary feedback mechanisms, have demonstrated measurable improvements in guideline adherence and patient outcomes. This narrative review integrates contemporary evidence and guideline recommendations to outline a practical framework for implementing reliable, high-quality lymph node staging in modern lung cancer surgery. Full article
(This article belongs to the Special Issue Innovations in Thoracic Surgery and Disease Management: Integrating Genomics, Technology, and Multidisciplinary Care)
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Other

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13 pages, 1009 KB  
Case Report
Post-Lobectomy Pleural Aspergillosis with Bronchopleural Fistula in a Patient with Metastatic Synovial Sarcoma of the Lung: A Case Report
by Angeliki Katsarou, Konstantinos Thomas, Ioannis Grigoropoulos, Anastasios Kyriazoglou, Elias Santaitidis, Periklis Tomos, Wiktoria Skórka, Magdalena Mnichowska-Polanowska, Małgorzata Edyta Wojtyś and Konstantinos Kostopanagiotou
J. Clin. Med. 2026, 15(5), 1734; https://doi.org/10.3390/jcm15051734 - 25 Feb 2026
Viewed by 431
Abstract
In clinical practice, healthcare providers encounter a rising incidence of aspergillosis, which significantly affects morbidity and mortality in vulnerable patients. Over the past few decades, molds have increasingly affected patients with underlying pleuropulmonary, hematological, or oncological diseases undergoing cytotoxic treatment or immunosuppression, leading [...] Read more.
In clinical practice, healthcare providers encounter a rising incidence of aspergillosis, which significantly affects morbidity and mortality in vulnerable patients. Over the past few decades, molds have increasingly affected patients with underlying pleuropulmonary, hematological, or oncological diseases undergoing cytotoxic treatment or immunosuppression, leading to impaired cell-mediated immunity and an increased risk of postoperative complications. Although the spectrum of Aspergillus infection is variable, ranging from allergic to chronic, invasive manifestation, pleural involvement is rarely reported. Pleural aspergillosis is an extrapulmonary manifestation of invasive aspergillosis, associated with thoracic surgical procedures and with a bronchopleural fistula, not necessarily combined with pulmonary aspergillosis. An elective or emergency thoracic surgery in immunocompromised patients increases the risk of postoperative infectious complications. Herein, we report a case of isolated postoperative pleural aspergillosis in a 28-year-old immunocompromised man with metastatic synovial sarcoma in the lungs, who underwent pleurodesis for pneumothorax, lobectomy for lung metastasis, and subsequently required decortication and thoracoplasty to achieve effective control of infection. To address this, the patient responded well to aggressive surgical debridement along with both systemic and intrapleural antifungal agent instillation. The essential in vitro diagnostics, including microscopy, microbiological culture and histopathological examination, both from necrotic pleural specimens, detected Aspergillus fumigatus, a global priority species of invasive aspergillosis. Postoperative aspergillosis with pleural involvement and bronchopleural fistula, in immunocompromised patients with sarcoma, is rarely reported, requiring a combination of surgical approach and optimized antifungal treatment regimens. The current knowledge on pleural aspergillosis management remains limited, and highlights the need for case reporting to refine expertise. Full article
(This article belongs to the Special Issue Innovations in Thoracic Surgery and Disease Management: Integrating Genomics, Technology, and Multidisciplinary Care)
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