Search Results (38)

Background: Three-dimensional virtual surgical planning (Three-dimensional VSP) has become standard practice in the treatment of mandibular oral squamous cell carcinoma (OSCC) in the last decade. Dutch guidelines recommend a care pathway interval (CPI) of a maximum of 30 days, and a free bone margin of at least 5 mm. Fused MRI and CT data are used for accurate tumor delineation. Based on this data, a virtual surgical plan is created and transferred to the operating room using resection guides and patient-specific implants (PSIs). Long-term evaluation is needed to further optimize its clinical use. Objectives: This study evaluates adherence to bone margin and CPI guidelines in mandibular OSCC. Additionally, it assesses the accuracy of tumor resection and reconstruction using 3D-VSP and compares the complications of 3D-planned mandibular reconstruction using different kinds of osteosynthesis plates. Methods: All patients who underwent a segmental mandibulectomy between 2014 and 2024 at the University Medical Center Groningen were included. CPI, clinical outcomes, and complications were analyzed. The preoperative virtual plan was compared with the postoperative outcome to assess accuracy. Results: The median CPI was 34 days, and 93.7% of bone margins were tumor-free. Mean absolute resection deviation was 1.63 mm (±1.42). PSI reconstructions were significantly more accurate in intergonial distance and coronal angle compared to conventional plates. Plate-related complications were more common in non-bony reconstructions; PSI reconstructions showed significantly more plate exposure. Conclusions: 3D-VSP leads to high accuracy in resection and reconstruction and favorable bone margins. Shortening the CPI and reducing biological complications are essential to further improve oncological outcomes. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article

Background: Primary fallopian tube carcinoma (PFTC) is a rare gynecologic malignancy, and data describing its biopsychosocial characteristics remain limited. Understanding the biological, psychological, and social features of affected women may support patient-centered care and inform future research. Methods: This retrospective, single-center, descriptive pilot study included 20 patients with histopathologically confirmed PFTC treated in 2024–2025. Demographic, reproductive, clinical, preventive, and record-documented psychosocial variables were extracted from medical records. Categorical variables were analyzed using chi-square tests (or Fisher’s exact test where appropriate), and effect sizes were summarized using Cramér’s V. Proportions were reported with 95% confidence intervals using the Wilson method. Results: Half of the women were aged ≥70 years (50.0%; 95% confidence interval (CI): 29.9–70.1) and 65.0% had never been pregnant. Normal body mass index (BMI) predominated (65.0%). International Federation of Gynecology and Obstetrics (FIGO) stage was available for 12/20 patients; among those with documented staging, 58.3% were FIGO stage III. Preventive behaviors documented in medical records suggested suboptimal screening patterns: cervical cytology was classified as occasional in 75.0% of patients. Psycho-oncological support was documented in 45.0% of patients, and sleep problems were documented in 25.0%. An age-group difference in documented psycho-oncological support was observed (χ² = 14.007; p = 0.007; Cramér’s V = 0.751); however, given the very small sample size and the distribution of observations across age categories, this finding should be interpreted as hypothesis-generating rather than confirmatory evidence. No association was observed between place of residence and FIGO stage in the subset with available staging data. Conclusions: In this small retrospective, single-center cohort, patients with PFTC were predominantly older and frequently nulligravid, while normal BMI was common. Record-documented psychosocial needs (including psycho-oncological support and sleep problems) were observed in a subset of patients and underscore the importance of systematic psychosocial assessment using validated tools in future studies and clinical pathways. Findings are preliminary and hypothesis-generating and support the need for larger prospective multicenter studies integrating comprehensive clinical and standardized psychosocial data in PFTC populations. Full article

Introduction: The appropriate use of antibiotic prophylaxis (AP) in surgical procedures is an ongoing debate. There is a lack of evidence, and urological guidelines provide limited, procedure-specific recommendations. Our aim was to develop a generic model of an audit to define the need for AP in urological procedures, as well as in other surgical specialties. Material and Methods: Based on our experience with the Global Prevalence of Infections in Urology (GPIU) study and a literature review, we defined benchmark standards for 30-day infection rates, including sepsis, and estimated the number of patients needed to be included in a comparative study of AP versus no AP for a surgical procedure within one year. The generic study model was developed during a modified consensus process within the UTISOLVE research group. Urology departments giving and not giving AP were invited to join our development project as an extension of GPIU. Results: Radical prostatectomy was used as a model procedure. Ca. 60 urology centers performing more than 50 radical prostatectomies per year signed up. There was variation in AP practice among sites. Our own review showed that infection rates were ca. 5%, with severe infections, including sepsis, occurring in <0.5% of cases. A sample of 1825 patients would be required to achieve a 95% confidence interval half-width of ±1.0% for general infections. For sepsis, assuming an incidence of 0.5%, a sample of 2124 patients would be needed to reach a 95% confidence interval precision of ±0.30%. Enrollment of 2070 consecutive procedures would be needed to yield precisions of ±0.94% for infection and ±0.30% for sepsis. Based on the number of procedures performed and the number of interested study sites, we agreed on a prospective, multi-center, non-interventional service evaluation, expected to collect standardized data over a 3-month period. The primary outcome was defined as the 30-day incidence of infectious complications. All patients will undergo 30-day post-procedure follow-up through routine clinical care pathways. Conclusions: Our audit model is based on benchmarking of relevant outcomes. It defines how to assess AP in surgical procedures and clarifies a series of issues necessary to defend the status of a generic study model. We regard DEEP-URO to be a comprehensive, multi-center-based initiative that will help balance infection prevention with antimicrobial stewardship and improve the quality of clinical practice and personalized medicine. Full article

Background: Temporomandibular disorders (TMDs) are the most common source of non-dental orofacial pain, with peak prevalence during adolescence and young adulthood—the same age group when orthodontic treatment is typically initiated. Although orthodontics is not a proven cause of TMD, pre-existing dysfunction may be aggravated during treatment, creating clinical and medico-legal risks. Objective: This paper proposes a structured diagnostic questionnaire and scoring framework for pre-orthodontic TMD assessment. The protocol aims to enhance the early recognition of high-risk patients, facilitate interdisciplinary communication, and lay a foundation for systematic validation. Methods: The framework was developed through synthesis of international diagnostic criteria (DC/TMD), a targeted narrative review of the literature, and expert clinical input. Diagnostic categories were selected based on prevalence, impact on orthodontic outcomes, and medico-legal significance. Weighted scoring stratifies patients into three pathways: (1) proceed with orthodontics without concern, (2) proceed with monitoring, or (3) defer orthodontics until TMD is managed. Results: The proposed questionnaire is designed to address inconsistencies in the literature by applying standardized diagnostic items and objective thresholds (e.g., jaw opening < 38 mm) and structured follow-up intervals. Case scenarios illustrate how risk stratification guides decision-making. The questionnaire includes intra-articular and pain-related TMD entities such as disk displacement, degenerative joint disease, myalgia, myofascial pain, arthralgia, headache, and trismus. The framework provides orthodontists with defensible baseline documentation while supporting safe and individualized patient care. Conclusions: Inconsistent diagnostic frameworks, malocclusion classifications, and outcome measures have fragmented the evidence base in orthodontics and TMD. The framework aims to provide orthodontists with structured baseline documentation that may support clinical decision-making and medico-legal risk management. Validation studies are required to establish psychometric reliability and international applicability. Full article

Background/Objectives: Introduction: Breast cancer remains a leading cause of cancer morbidity and mortality among women, and timely diagnosis is critical for improving outcomes. Organized screening programs strive to function efficiently, with minimal delays; however, evidence indicates that longer waiting times may be present at different stages of the diagnostic process. Few studies have evaluated how socio-demographic, reproductive, lifestyle, and clinical characteristics may influence diagnostic timeliness in a regional screening context. Materials and Methods: We retrospectively analyzed data from 240 women who underwent breast biopsy following abnormal screening assessment, out of 24,000 patients enrolled in a regional breast cancer screening program conducted in Northeastern and Southeastern Romania. Diagnostic timeliness was observed across three consecutive intervals of the screening pathway: mammography to biopsy (T1), biopsy to histopathological confirmation (T2), and cumulative presentation-to-diagnosis time (T3). Baseline population characteristics were described, subgroup comparisons performed, and multivariable regression models applied to identify independent predictors of diagnostic delay and to explore interaction effects at different stages of the screening process. Results: The interval between mammography and biopsy accounted for the most substantial waiting times (T1 median 24 days). The cumulative time to diagnosis (T3) reached a median of 32 days. Territorial inequalities were the strongest determinant of delay: rural patients experienced approximately five additional days before histopathological confirmation compared with urban patients (p = 0.003). Social vulnerability further contributed to prolonged T1 and T3 intervals, while lifestyle, reproductive, and anthropometric factors showed only minor or inconsistent associations. Interaction analyses revealed that delays linked to rural residence were most pronounced among younger women, an age group at higher risk for aggressive subtypes such as triple-negative breast cancer. Conclusions: In our findings, regional background and social vulnerability outweighed individual risk factors in shaping total diagnostic time. These results support the careful monitoring of interval-specific performance to strengthen equitable access to biopsy among vulnerable populations, where the effectiveness of early breast cancer detection is often challenged. Full article

Background/Objectives: A significant proportion of patients with angina undergoing invasive coronary angiography have no obstructive coronary artery disease (ANOCA), often due to coronary microvascular dysfunction (CMD). Coronary function testing (CFT) enables the physiological endotyping of these patients during angiography. This meta-analysis aimed to evaluate whether CFT-guided therapy improves angina symptoms and quality of life compared with standard angiography-guided care. Methods: Major databases were systematically searched for randomised controlled trials (RCTs) up to September 2025. The primary endpoint was angina severity; secondary endpoints included angina limitation, stability, frequency, treatment satisfaction, and quality of life. Pooled analyses were performed using a random-effects model with inverse-variance weighting to derive the weighted mean difference (95% confidence interval, CI). Results: Three RCTs involving 535 patients (mean age 60 years, 64% female) met inclusion criteria. The disclosure of CFT results did not significantly improve overall angina severity (mean difference: 6.00, 95% CI −2.32 to 14.33; p = 0.16), with considerate heterogeneity (I² = 92%). No difference was observed for angina frequency or quality of life. In contrast, angina limitation, stability, and treatment satisfaction all favoured the CFT-disclosed group, although the results were heterogeneous. Conclusions: Invasive CFT appears feasible and clinically relevant in patients with ANOCA. Although several SAQ domains improved following physiology-guided management, these findings require cautious interpretation given the modest sample size and considerable heterogeneity. Larger, methodologically robust trials are warranted to clarify whether a CFT-guided strategy should be routinely integrated into the diagnostic and therapeutic pathway for ANOCA. Full article

Background/Objectives: Lumbar degenerative disease drives numerous elective spine surgeries, and anesthetic choice significantly influences airway risk, hemodynamics, analgesia, mobilization, and recovery. Interest in awake lumbar surgery, typically using spinal anesthesia (SA) with light sedation, has grown as comparative studies suggest comparable safety to general anesthesia (GA) with potential reductions in opioid use, nausea, time to ambulation, and efficiency metrics. However, these benefits may be context-dependent under standardized perioperative care. Therefore, the aim of this umbrella review is to synthesize previously published meta-analyses that compare postoperative outcomes between SA and GA in patients undergoing lumbar spine surgery. Methods: A systematic literature search was executed with defined criteria across PubMed, Embase, and Web of Science. Data analysis was performed using the metaumbrella R package to report equivalent Hedges’ g values. Each meta-analysis was evaluated with the AMSTAR2 tool, and the credibility of the evidence was determined with Ioannidis criteria. Results: Seven meta-analyses were included. Pooled data showed that SA was associated with shorter operative time, reduced length of stay, and lower intraoperative blood loss, supported by class III credibility for operative time and length of stay and class IV for blood loss in the setting of high between study heterogeneity. SA was also associated with lower odds of postoperative nausea and vomiting and reduced postoperative analgesic requirements, both graded as class IV with prediction intervals that encompassed the null. Intraoperative hypotension and bradycardia did not differ significantly between SA and GA, and postoperative pain scores and overall complication rates were similarly neutral. Conclusions: This umbrella review identifies potential advantages of SA in lumbar spine surgery, including shorter operative time, reduced length of stay, lower intraoperative blood loss, and lower postoperative nausea and analgesic requirements, while finding no consistent differences in hemodynamic events or overall complications. These findings suggest SA as an alternative pathway to general anesthesia for selected lumbar procedures but highlight substantial heterogeneity and low-to-intermediate credibility for several endpoints, underscoring the need for additional high-quality, protocolized comparative studies to refine effect sizes and define optimal patient and procedural selection. Full article

Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care. Full article

Background: Breast cancer-related lymphedema (BCRL) is a common and debilitating treatment-related adverse event that can profoundly impact quality of life and financial well-being. Although prospective surveillance and early intervention for BCRL have been shown to reduce the incidence and severity of this chronic condition, diagnostic accuracy of screening, programmatic utilization and efficacy vary widely. We describe the protocol for the BCRL Prospective Surveillance Model (PSM) and Early Intervention Program at the Dana-Farber Brigham Cancer Center that aims to address these issues by augmenting arm measurements (standard of care) with use of patient-reported outcome metrics (PROMs). Methods: Women with newly diagnosed stage I-III breast cancer at high risk for developing BCRL based on tumor and treatment characteristics are eligible for inclusion in our PSM care pathway, which uses both the Breast Cancer and Lymphedema Symptom Experience Index PROMs and arm measurements for screening. Screening begins prior to the initiation of neoadjuvant therapy and continues at regular intervals postoperatively. A positive screen, defined as new patient-reported arm swelling/heaviness and/or relative volume change (RVC) ≥ 5% in the affected limb, triggers consideration for multidisciplinary early intervention. Analysis: The BCRL detection rate will be compared to years previous to protocol development. PSM feasibility will be determined according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Efficacy of the PSM will be gauged by comparing change in patient-reported outcomes of interest and arm volume measurement pre and post early intervention. Feasibility will be determined by calculating the percentage of PSM-eligible individuals who complete all PSM activities in a 1-year span. Characteristics of participants versus non-participants in the target population will be compared. Furthermore, 1:1 semi-structured interviews with enrolled patients will be performed to understand facilitators and barriers to implementation. Conclusions: The findings from this study will be used to develop a standardized approach to PSM and early intervention that can be adapted to both resource-modest and resource-abundant healthcare infrastructures. Full article

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder in which early diagnosis improves quality of life and reduces disability. However, diagnostic delays remain common, particularly in low- and middle-income countries. This study investigated clinical and system-level factors contributing to diagnostic delay in Thailand. Methods: A retrospective chart review was conducted on patients newly diagnosed with PD at Thammasat University Hospital between June 2020 and June 2024. Demographic, clinical, and healthcare access data were analyzed. Diagnostic intervals were defined as onset-to-visit (OTV), visit-to-diagnosis (VTD), and onset-to-diagnosis (OTD). Age-at-onset groups included early-onset Parkinson’s disease (EOPD, <50 years), regular-onset PD, and very-late-onset PD (≥80 years). Results: Of 1093 patients screened, 109 newly diagnosed PD cases met the inclusion criteria. The median OTV was 360 days, and the median VTD was 10 days. Tremor was the most frequent initial symptom (75%). Patients with higher education and extended family support sought care earlier, whereas those under the Universal Coverage Scheme (UCS) experienced longer OTD durations (median, 541 vs. 181 days in privately insured patients). More than half of patients were initially misdiagnosed, especially when first evaluated by non-neurologists. Conclusions: Diagnostic delay in Thai PD patients stems mainly from late help-seeking and inequities in healthcare access. Addressing these gaps requires public awareness, physician training, streamlined UCS referral pathways, and adoption of biomarker-supported digital tools to ensure earlier and more equitable diagnosis. Full article

Background: Endometriosis is a chronic disease defined by the presence of endometrial-like tissue outside the uterine cavity. While typically confined to the pelvis, extrapelvic manifestations—including thoracic endometriosis—can occur. Although rare, thoracic endometriosis is the most common extragenital form. In clinical practice, this presentation is often described as thoracic endometriosis syndrome (TES), a constellation of cyclic thoracic symptoms temporally associated with menstruation but not always histologically confirmed. Its atypical symptoms and limited clinical awareness frequently lead to delayed diagnosis, mismanagement and increased patient burden. Methods: In accordance with the CARE guidelines, we present a case report of a female patient with thoracic endometriosis syndrome, emphasizing the prolonged interval between symptom onset and final diagnosis. Case Report: We describe a 42-year-old woman with a longstanding history of dysmenorrhea and menorrhagia, who developed cyclical chest pain and dyspnea in 2019. Despite multiple thoracoscopic procedures, her symptoms persisted and were repeatedly misattributed to anxiety or infection. Thoracic endometriosis syndrome (TES) was suspected in 2022, and although histopathological confirmation was lacking, intraoperative visualization revealed diaphragmatic fenestrations. In 2025, a second laparoscopic intervention targeting the abdominal surface of the diaphragm resulted in significant symptom relief. The patient is currently continuing hormonal therapy with Dienogest and has reported a marked improvement in quality of life. Nevertheless, the protracted diagnostic and therapeutic process—marked by chronic pain and repeated hospitalizations—had a profound psychosocial impact, culminating in a suicide attempt. Conclusions: This case illustrates the substantial burden associated with the delayed recognition of thoracic endometriosis syndrome and the consequences of fragmented care. The patient’s experience underscores the urgent need for coordinated, multidisciplinary management and psychological support, particularly for patients with extrapelvic manifestations. Early multidisciplinary evaluation, with readiness to consider surgical intervention alongside individualized hormonal therapy, may support improved outcomes, provided they are reinforced by increased clinical awareness and systemic improvement in diagnostic pathways. Full article

Existing drainage systems have limited capacity to mitigate future climate change-induced flooding problems effectively. However, some studies have evaluated the effectiveness of integrating Water-Sensitive Urban Design (WSUD) with existing drainage systems in mitigating flooding in tropical regions. This study examined the performance of drainage systems and integrated WSUD options under current and future climate scenarios in a sub-catchment of Saltwater Creek, a tropical catchment located in Cairns, Australia. A combination of one-dimensional (1D) and two-dimensional (1D2D) runoff generation and routing models (RORB, storm injector, and MIKE+) is used for simulating runoff and inundation. Several types of WSUDs are tested alongside different climate change scenarios to assess the impact of WSUD in flood mitigation. The results indicate that the existing grey infrastructure is insufficient to address the anticipated increase in precipitation intensity and the resulting flooding caused by climate change in the Engineers Park sub-catchment. Under future climate change scenarios, moderate rainfall events contribute to a 25% increase in peak flow (95% confidence interval = [1.5%, 0.8%]) and total runoff volume (95% confidence interval = [1.05%, 6.5%]), as per the Representative Concentration Pathway 8.5 in the 2090 scenario. Integrating WSUD with existing grey infrastructure positively contributed to reducing the flooded area by 18–54% under RCP 8.5 in 2090. However, the efficiency of these combined systems is governed by several factors such as rainfall characteristics, the climate change scenario, rain barrel and porous pavement systems, and the size and physical characteristics of the study area. In the tropics, the flooding problem is estimated to increase under future climatic conditions, and the integration of WSUD with grey infrastructure can play a positive role in reducing floods and their impacts. However, careful interpretation of results is required with an additional assessment clarifying how these systems perform in large catchments and their economic viability for extensive applications. Full article

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical psychologists regarding online psychotherapy for patients with suicidal behavior in the context of the COVID-19 pandemic, to generate a theoretical understanding of this experience. It is a qualitative, exploratory, longitudinal study based on the Constructivist Grounded Theory framework. Ten clinical psychologists who conducted online psychotherapy for patients with suicidal behavior during the pandemic were interviewed at two moments, with an interval of approximately two years: the first round was conducted from December 2020 to March 2021, followed by a second round between November and December 2022. Data analysis led to four categories: (1) Reflecting on suicidal behavior; (2) Addressing specificities of online interventions; (3) Managing suicidal behavior in online psychotherapy; (4) Evaluating online psychotherapy for patients with suicidal behavior. The theoretical model “Pathways of care: main roads and access routes in online psychotherapy for suicidal behavior” was constructed. It was concluded that online psychotherapy for patients with suicidal behavior is complex and requires caution but is feasible and can be important in specific circumstances. This makes it an additional resource for suicide prevention and mental health promotion. Full article

Background: The COVID-19 pandemic prompted concerns about delays in cancer diagnosis and treatment, particularly for lung cancer (LC). We assessed the impact of the pandemic on lung cancer care, diagnostic efficiency, treatment timelines, and short-term survival in a Spanish tertiary hospital. Methods: We performed a retrospective cohort study including 530 patients diagnosed with primary lung cancer from March 2019 to March 2022. Patients were grouped into three cohorts: pre-pandemic (2019), first pandemic year (2020), and second pandemic year (2021). Key intervals—referral-to-diagnosis and diagnosis-to-treatment—along with survival outcomes were compared across cohorts. Multivariate Cox regression identified independent predictors of mortality. Results: LC diagnoses declined by 19% in 2020, rebounding by 42% in 2021. The proportion of patients receiving the first definitive treatment remained stable (~70%). Diagnostic timeliness improved: the median referral-to-diagnosis interval shortened from 19 to 14 days (p < 0.0001), with >80% of patients diagnosed within 30 days throughout all periods. Molecular testing turnaround increased (median 11 to 15 days, p = 0.0226). The diagnosis-to-treatment interval remained unchanged (median 34–35 days). One-year survival improved from 37% (2019) to 43% (2020–2021), and two-year survival from 22% to 30%. In multivariate analysis, only advanced stage and poor ECOG performance status independently predicted mortality; delays in diagnosis or treatment had no significant impact. Conclusions: Despite pandemic-related disruptions, essential LC care and short-term outcomes were largely maintained in our center. Early stage at diagnosis and favorable performance status outweighed the effect of moderate delays. Health system resilience and streamlined care pathways proved critical for sustaining cancer outcomes during the COVID-19 crisis. These findings offer actionable lessons for the Spanish healthcare system and may help guide national preparedness strategies for future oncologic crises. Full article