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Current Challenges and Future Directions in Lung Resections in Thoracic...
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Current Challenges and Future Directions in Lung Resections in Thoracic Surgery

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

Deadline for manuscript submissions: closed (15 June 2026) | Viewed by 5082

Editors

Dr. Vasileios K. Kouritas

E-Mail Website
Guest Editor
The Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK
Interests: thoracic surgery; lung volume reduction – endobronchial valves – lung volume reduction surgery – hybrid procedures; robotic surgery (RATS); implementation of high-risk MDTs in thoracic surgery; mediastinal surgery
Dr. Emmanuel Michael Kefaloyannis

E-Mail Website
Guest Editor
University General Hospital of Heraklion, 715 00 Heraklion, Greece
Interests: VATS; thoracic surgery; endobronchial stents; lung cancer

Special Issue Information

Dear Colleagues,

The evolution in the practice of thoracic surgery has been astonishing during the last decade. Many new technologies and modalities have been rolled out to everyday practice, constituting surgical treatment possible in more patients and in pathologies that previously were not amendable to treatment. Some examples include the utilization of robotic platforms in minimally invasive approaches, the evolution of lung volume reduction interventions in the form of surgery, valves, or hybrid procedures, the increasing performance of sublobar anatomical lung resections in lung resections, the implementation of screening services for lung cancer, the utilization of artificial intelligence in the research and clinical practice of thoracic surgeons, the application of 3D reconstructions and marking of lesions in lung resections, the implementation of targeted therapy as multimodal treatment in lung cancer, and many others.

In this Special Issue, we welcome authors to submit manuscripts that provide a comprehensive connection between present challenges and future directions in thoracic surgery with the implementation of the abovementioned evolutionary new developments within the specialty.

Dr. Vasileios K. Kouritas
Dr. Emmanuel Michael Kefaloyannis
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-anonymized 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

  • robotic-assisted thoracic surgery (RATS)
  • robotic
  • sublobar
  • 3D
  • emphysema
  • endobronchial valves
  • lung volume reduction surgery (LVRS)
  • high-risk
  • AI
  • research
  • lung
  • screening
  • lung cancer

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Published Papers (4 papers)

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Research

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11 pages, 223 KB  
Article
Is Neoadjuvant Chemoimmunotherapy Safe in Surgically High-Risk Lung Cancer Patients? A Single-Centre IPTW Analysis
by Fathima Shafra Mubarak, Muneeb Khalid, Jose Alvarez Gallesio, Marco Nardini, Joshil Lodhia, Elaine Teh, Nilanjan Chaudhuri, Kostas Papagiannopoulos, Richard Milton, Alessandro Brunelli and Peter Tcherveniakov
J. Clin. Med. 2026, 15(15), 6069; https://doi.org/10.3390/jcm15156069 - 4 Aug 2026
Viewed by 288
Abstract
Background: Neoadjuvant chemoimmunotherapy is now a standard approach for resectable stage II–III non-small cell lung cancer (NSCLC), demonstrating improved pathological response and survival. However, its safety in physiologically high-risk surgical patients is unclear, as these groups are underrepresented in trials. This study compares [...] Read more.
Background: Neoadjuvant chemoimmunotherapy is now a standard approach for resectable stage II–III non-small cell lung cancer (NSCLC), demonstrating improved pathological response and survival. However, its safety in physiologically high-risk surgical patients is unclear, as these groups are underrepresented in trials. This study compares 30-day and 90-day mortality and oncological outcomes of neoadjuvant chemoimmunotherapy followed by surgery versus upfront surgery within a high-risk multidisciplinary team (MDT) cohort. Methods: A retrospective single-centre study was performed, including consecutive high-risk MDT patients undergoing resection for stage II -III NSCLC between January 2022 and December 2025. High-risk status was defined by established physiological, cardiopulmonary, and comorbidity criteria. Patients were stratified into neoadjuvant chemoimmunotherapy followed by surgery (Chemo-IO; n = 33) or upfront surgery (n = 57). The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, R0 resection rate, and length of hospital stay. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance baseline differences between groups. Results: Ninety patients were included. Patients receiving neoadjuvant therapy had a greater comorbidity burden (Charlson Comorbidity Index 3.2 ± 1.5 vs. 1.4 ± 1.7, p < 0.001) and more advanced disease (stage III: 57.6% vs. 29.8%, p = 0.014). Thirty-day mortality was 0% in the Chemo-IO group and 1.8% following upfront surgery. After IPTW adjustment, neoadjuvant therapy was not associated with increased perioperative mortality. Ninety-day mortality was similar between groups (3.0% vs. 3.5%; IPTW OR 0.91, 95% CI 0.05–15.39, p = 0.948). R0 resection rates were numerically higher following Chemo-IO (87.9% vs. 78.9%; IPTW OR 3.42, 95% CI 0.71–16.59, p = 0.127). Median hospital stay was identical in both cohorts (6 days), with no significant difference after weighting (p = 0.722). Conclusions: Neoadjuvant chemoimmunotherapy appears safe and feasible in carefully selected high-risk patients with resectable stage II–III NSCLC. Despite greater comorbidity burden and more advanced disease, short-term perioperative outcomes were not compromised, while a trend towards improved R0 resection rates was observed. These findings support the consideration of multimodal treatment strategies within high-risk MDT pathways. Full article
(This article belongs to the Special Issue Current Challenges and Future Directions in Lung Resections in Thoracic Surgery)
16 pages, 675 KB  
Article
Rethinking pN1 Disease in Non-Small Cell Lung Cancer: Anatomical Subclassification, Surgical Extent, and Survival Outcomes
by Eyüp Halit Yardımcı, Aleyna Gültekin Arıdaş, Sezer Aslan, Tunç Laçin and Korkut Bostancı
J. Clin. Med. 2026, 15(10), 3950; https://doi.org/10.3390/jcm15103950 - 20 May 2026
Viewed by 378
Abstract
Background: Pathological N1 (pN1) non-small cell lung cancer (NSCLC) presents variable survival; yet, the TNM system lacks N1 subclassification. While studies focus on numerical nodal burden, the prognostic impact of anatomical location remains unclear. Surgically, completion lobectomy is advised after sublobar resection [...] Read more.
Background: Pathological N1 (pN1) non-small cell lung cancer (NSCLC) presents variable survival; yet, the TNM system lacks N1 subclassification. While studies focus on numerical nodal burden, the prognostic impact of anatomical location remains unclear. Surgically, completion lobectomy is advised after sublobar resection for N1-positive disease. However, for hilar/interlobar involvement—where residual lymphatic pathways remain post-lobectomy—extension to pneumonectomy is rarely performed, raising uncertainty about the optimal extent of resection in different pN1 subgroups. Methods: This retrospective study evaluated 150 patients with pN1 NSCLC who underwent curative-intent anatomical lung resection and systematic nodal dissection (2012–2023). The follow-up period extended from the date of surgery to death or last follow-up, with survival status assessed until March 2026. Clinicopathological variables, including anatomical N1 level, nodal burden, tumor characteristics, and surgical extent, were analyzed alongside survival outcomes. Results: Peripheral N1 involvement (stations 12–14) yielded significantly longer survival than hilar/interlobar metastasis (stations 10–11) (p = 0.019). Nodal count and multiple-station involvement did not impact survival. Age (HR: 1.036, p = 0.026) and interlobar station 11 pN1 positivity (HR: 1.912, p = 0.044) emerged as independent negative prognostic factors for overall survival. Perineural invasion worsened survival in Stage III disease. Extended resections offered no survival benefit and worsened outcomes in hilar/interlobar disease. Conclusions: The anatomical level of N1 metastasis is a key prognostic factor in pN1 NSCLC. Standard lobectomy appears sufficient across all subgroups, including hilar/interlobar disease, while extended resections do not improve survival. Future studies should clarify systemic/adjuvant treatment strategies. Full article
(This article belongs to the Special Issue Current Challenges and Future Directions in Lung Resections in Thoracic Surgery)
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9 pages, 222 KB  
Article
Next-Day Discharge Is Feasible in Robotic-Assisted Thoracic Surgery Anatomical Lung Resections Irrespective of Patient Characteristics
by Ra’fat Tawalbeh, William Ansley, Obada Alqudah, Ahmad Asqalan, Hammad Hassan, Bartolmiej Szafron, Cristina Viola, Jakub Kadlec, Waldemar Bartosik and Vasileios Kouritas
J. Clin. Med. 2025, 14(9), 3198; https://doi.org/10.3390/jcm14093198 - 5 May 2025
Viewed by 1143
Abstract
Background: Next-day discharge post-robotic-assisted thoracic surgery (RATS) anatomical lung resections are shown to be achieved in young and fit patients. This study aims to compare next-day discharge RATS anatomical lung resection patients matched with patients who stayed longer. Methods: A retrospective analysis of [...] Read more.
Background: Next-day discharge post-robotic-assisted thoracic surgery (RATS) anatomical lung resections are shown to be achieved in young and fit patients. This study aims to compare next-day discharge RATS anatomical lung resection patients matched with patients who stayed longer. Methods: A retrospective analysis of patients who underwent RATS anatomical lung resection by a single surgeon was conducted. Based on the variables found to be different, two propensity-matched groups were created: a next-day discharge group and a group of patients with longer stays. Results: This study included 202 patients, 49 (24.3%) of whom were discharged the next day. The mean age was 68.3 ± 9.8 years, and 114 (56.4%) patients were females. Based on the variables found different, two matched groups with 46 patients for age, gender, performance score, American Society of Anesthesiologists score, number of co-morbidities and Forced Expiratory Volume in 1 sec were created. Re-admissions, complications, and death rates were similar, but next-day discharge patients had more sublobar resections (65.2% vs. 37%, p = 0.029), shorter procedures (132 vs. 179 min, p = 0.048), and morning theater slots (71.7% vs. 32.6, p = 0.018). These were shown to be independent predictors of next-day discharge. Major air leak issues also kept patients in the hospital longer (23.9% vs. 6.5%, p = 0.024). Conclusions: Next-day discharge following RATS anatomical lung resection appeared to have no increased risk of re-admissions or complications, irrespective of fitness, age, or other patient characteristics. Patients receiving short-duration surgery and morning sublobar resections without major air leak issues have higher chances of achieving next-day discharge. Full article
(This article belongs to the Special Issue Current Challenges and Future Directions in Lung Resections in Thoracic Surgery)

Other

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10 pages, 1375 KB  
Case Report
Giant Chest Wall Metastasis of Rectal Adenocarcinoma with Multistructural Involvement
by Dawid Murawa, Joanna Jaśkiewicz, Zachariasz Rytelewski, Aleksander Murawa, Paula Dobosz, Tomasz Grodzki and Paweł Zieliński
J. Clin. Med. 2026, 15(7), 2654; https://doi.org/10.3390/jcm15072654 - 31 Mar 2026
Viewed by 2612
Abstract
Introduction and Importance: Colorectal adenocarcinoma typically metastasizes to the liver and lungs, with pleural, breast, or osseous involvement being exceedingly rare. Here, we report an unusual case of rectal adenocarcinoma metastasizing to the chest wall with simultaneous involvement of the lung, pleura, [...] Read more.
Introduction and Importance: Colorectal adenocarcinoma typically metastasizes to the liver and lungs, with pleural, breast, or osseous involvement being exceedingly rare. Here, we report an unusual case of rectal adenocarcinoma metastasizing to the chest wall with simultaneous involvement of the lung, pleura, ribs, and subcutaneous breast tissue, forming a dominant giant metastasis (25 × 18 × 16 cm) accompanied by additional satellite lesions between the ribs and pectoral muscles, as well as intrapulmonary nodules. Presentation of case: The patient underwent radical resection including rib excision, followed by hyperthermic intrathoracic chemotherapy (HITHOC) with mitomycin. Chest wall integrity was restored using a synthetic mesh and titanium plating, ensuring both oncologic clearance and structural stability. Multimodal therapy also included neoadjuvant chemotherapy with bevacizumab, which was continued postoperatively. Clinical discussion: This case underscores the critical role of a multidisciplinary strategy in managing rare and aggressive metastatic patterns of colorectal cancer. In selected patients, a combination of systemic therapy, extensive surgical resection, advanced reconstruction, and regional chemotherapy may offer the potential for short-term local disease control. Conclusions: The radical excision of the giant tumour enabled continuation of systemic therapy under the national drug programme, was associated with short-term local control, and improved the patient’s quality of life. Full article
(This article belongs to the Special Issue Current Challenges and Future Directions in Lung Resections in Thoracic Surgery)
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