Minimally Invasive Thoracic Surgery: Risk Assessment and Personalized Perioperative Management

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 755

Special Issue Editors


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Guest Editor
Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy
Interests: minimally invasive thoracic surgery; ERAS; uniportal VATS; sublobar resections; postoperative risk assessment

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Guest Editor
Thoracic Surgery Department, University of Perugia Medical School, 06129 Perugia, Italy
Interests: minimally invasive thoracic surgery; chest wall surgery; tracheal surgery; surgical treatment of pleural diseases; surgical treatment of locally advanced stages of lung cancer; surgery after induction treatment; STAS; lung regeneration
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Special Issue Information

Dear Colleagues,

As already widely reported, the role of video-assisted thoracic surgery (VATS) has emerged and made a great contribution to the early postoperative period after pulmonary resection for cancer. As more patients are at high risk of developing cardiopulmonary complications, the outcome of performing VATS is improving.

Preoperative cardiopulmonary function tests were traditionally performed for open surgery to assess resection feasibility, but now these tests may no longer be predictors of postoperative complications. A personalized perioperative management based on tailored surgical procedures and more patient-centered standardized pathways of care (e.g., ERAS) are of primary importance to enhance the perioperative course, disputing the traditional standards of care.

Regarding surgical resection, VATS sublobar resection represents a useful alternative treatment, especially in the elderly population with severe comorbidities or in patients considered to be at high risk for postoperative complications.

Additionally, VATS is a key element of ERAS. This new paradigm of care after surgery is able to reduce the stress response to surgery, providing the patient with an active role in their “patient-centered strategy” for a prompt recovery.

This Special Issue aims to highlight new perspectives on the personalized perioperative management of patients with lung cancer, analyzing surgical risk stratification, possible new predictors of complications, tailored surgical approaches, and evolutions of perioperative pathways of care.

In this Special Issue, we aim to set a clear focus on how these strategies of care are substantially revolutionizing patient management and whether the direction of future anticipated outcomes is confirmed or not. New advances in each aspect and the value of recent scientific achievements to assess the current therapeutic horizon of lung cancer patients are welcomed to be submitted to this Special Issue.

Dr. Marco Andolfi
Dr. Vannucci Jacopo
Guest Editors

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Keywords

  • VATS
  • ERAS
  • sublobar resection
  • risk assessment
  • minimally invasive thoracic surgery

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Published Papers (1 paper)

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Research

11 pages, 1000 KB  
Article
Contralateral Recurrence and Temporal Trend After First Side Surgery for Primary Spontaneous Pneumothorax: A Multicenter Analysis
by Antonio Giulio Napolitano, Dania Nachira, Gloria Santoro, Eleonora Coviello, Maria Teresa Congedo, Marco Sanguigni, Domenico Pourmolkara, Chiara Scognamiglio, Leonardo Petracca Ciavarella, Adriana Nocera, Maria Letizia Vita, Felice Mucilli, Jacopo Vannucci, Elisa Meacci, Francesco Puma, Filippo Lococo and Stefano Margaritora
J. Pers. Med. 2026, 16(5), 257; https://doi.org/10.3390/jpm16050257 - 9 May 2026
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Abstract
Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence [...] Read more.
Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence assessing the potential role of clinical factors in risk stratification. Methods: A total of 479 patients surgically treated for PSP (2012–2024) across three Italian high-volume centers were retrospectively reviewed. Secondary pneumothorax, patients <18 years old, lung emphysema or intraparenchymal large bullae, and the thoracotomy approach were excluded. The association between categorical variables and contralateral recurrence was assessed using the chi-square (χ2) test, while the association with continuous variables was evaluated using the t-test. Time to recurrence was analyzed using Kaplan–Meier survival curves. Variables with a p-value < 0.05 were considered statistically significant. Results: We identified 59 patients who experienced contralateral recurrence: 45 were males, the mean age was 26.66 ± 12.32 and the mean BMI was 22.00 ± 2.92; only 13 were active smokers. Age (p < 0.001) and smoking history (p = 0.029) were significantly associated with contralateral recurrence in univariate analysis, though these were not confirmed in multivariate analysis. Among the cohort of recurrence, 53 patients only had a recurrence on the contralateral side, with a median time to recurrence of 139 days. The incidence rate ratio (IRR) of recurrence for patients with a mean age of <34 years was 1.23, which translates to a 23% increased risk. No significant impact of age (p = 0.25), sex (p = 0.67), or smoking (p = 0.59) on the time to recurrence on the other side was observed through Kaplan–Meier analysis. The peak incidence for the first episode of PNX surgically treated and contralateral recurrence was observed in October, November and January. Conclusions: This study highlights a 12% contralateral recurrence rate after PSP surgery. Younger age is associated with earlier contralateral recurrence. Seasonality may influence recurrence patterns. Further studies should explore underlying mechanisms and preventive strategies. Full article
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