Search Results (3,248)

Background: Hepatitis B virus infection has been linked to liver cancer and may influence metastasis in other malignancies, but its role in gastric cancer liver metastasis (GCLM) is unclear. Methods: We retrospectively analyzed 776 gastric cancer patients with HBV testing. HBV infection was defined as HBsAg+ (chronic HBV, CHB) or HBsAg− with HBcAb/HBeAb+ (occult HBV, OHB). Among the 776 patients, 300 (38.6%) were classified as HBV+. The association between HBV infection and GCLM was evaluated, and propensity score matching (PSM) was performed to adjust for age and gender. Furthermore, the impact of HBV infection on overall survival (OS) was analyzed. Results: GCLM occurred in 19.5% of patients. HBV+ patients had a higher GCLM prevalence than HBV− patients (25.3% vs. 15.8%; p = 0.001), persisting after PSM (25.3% vs. 15.3%; p = 0.002). HBV infection was an independent risk factor for GCLM (OR = 2.563, p < 0.001). Both OHB and CHB groups showed significantly higher GCLM rates than HBV− patients in univariate and multivariate analyses. However, OS did not differ between groups (p = 0.737). Conclusion: HBV infection significantly increases the risk of liver metastasis in gastric cancer. Enhanced surveillance for liver metastasis is warranted in these patients. Full article

Background and Objectives: To evaluate the impact of liver cirrhosis on pregnancy outcomes using a large-scale, propensity score-matched cohort, with adjustment for numerous confounding variables. Materials and Methods: From a total of 3,701,876 pregnancies (women aged 18–49) from 1 January 2010, to 31 December 2024, after propensity score matching, 2498 pregnancies with cirrhosis and 2498 pregnancies without cirrhosis in TrinetX database were included in our analysis. To adjust for potential confounding, pregnancies in the cirrhosis group were matched 1:1 to those without cirrhosis using propensity scores derived from demographic, lifestyle, comorbidity, and laboratory characteristics. Relative risks (RRs), risk differences (RDs), and corresponding 95% confidence intervals (CIs) were calculated for pregnancy-related outcomes. Subgroup analyses stratified by maternal age were further performed to assess potential effect modification. Main outcomes included Gestational diabetes mellitus, preeclampsia, premature rupture membranes, preterm birth, miscarriage, stillbirth, placental abruption, dystocia, postpartum hemorrhagia, and cesarean delivery. Results: After matching, 2485 women were included in each group, with well-balanced baseline characteristics. Compared with women without cirrhosis, those with cirrhosis had a higher risk of pregnancy-related outcomes, including gestational diabetes mellitus (15.5% vs. 11.9%; RR = 1.30; 95% CI, 1.13–1.50, p < 0.001), preeclampsia (8.6% vs. 5.7%; RR = 1.52; 95% CI, 1.24–1.87, p < 0.001), and preterm birth (9.0% vs. 4.9%; RR = 1.85; 95% CI, 1.49–2.29, p < 0.001). Cirrhosis during pregnancy was also associated with a higher risk of miscarriage (6.6% vs. 4.8%), stillbirth (1.3% vs. 0.5%), placental abruption (1.8% vs. 0.8%), postpartum hemorrhage (6.9% vs. 4.3%), and cesarean delivery (20% vs. 17.2%). The limitations include the lack of detailed data on cirrhosis severity. Conclusions: Pregnancy with liver cirrhosis is associated with increased risks of diverse maternal and neonatal complications. Our findings highlight the importance of multidisciplinary management and individualized care planning in order to reduce adverse outcomes. Full article

Background: The survival benefits of kidney transplantation (KT) versus dialysis in elderly end-stage renal disease (ESRD) patients, particularly those with cardiovascular disease (CVD), remain uncertain. Methods: This retrospective single-center study included 1060 patients aged ≥60 years: 165 KT recipients and 895 dialysis patients. Propensity score matching using five covariates (age, sex, cardiac disease, cerebrovascular accident, and hemodialysis duration) created balanced cohorts of 123 patients per group. Kaplan–Meier analysis and multivariate Cox regression were performed in the matched cohort, and a time-dependent Cox model was additionally applied to the full cohort to address immortal time bias. Results: In the propensity score-matched cohort, KT (HR = 2.72, p = 0.009), age (HR = 1.13, p < 0.001), and CVD morbidity (HR = 3.84, p < 0.001) were independent predictors of mortality. In the time-dependent Cox analysis, KT was not significantly associated with overall survival (HR = 0.94, p = 0.837), but a significant KT × CVD interaction was identified (HR = 3.34, p = 0.025): KT was associated with reduced mortality in patients without CVD (HR = 0.47, p = 0.121) and increased mortality in those with CVD (HR = 1.67, p = 0.174). In patients aged ≥65 years with CVD, KT recipients demonstrated significantly worse survival than dialysis patients (p = 0.004). Conclusions: After correcting for immortal time bias, KT was not significantly associated with overall survival in elderly patients. However, the significant KT × CVD interaction suggests that CVD status is a critical determinant of transplant outcomes. Full article

The physical and mental health of adolescents is a cornerstone of national future. However, traditional “one-size-fits-all” school health interventions often fail to address the diverse needs of students. To overcome this limitation, this research introduces an evidence-based, tiered intervention model designed to provide personalized health support. This study constructs and validates a dynamic ‘Dynamic Weighting-based Asset-Condition-Resource Allocation-Evaluation-Feedback’ (DWA-CRISPR) tiered intervention model, moving from a “triage-driven” to a “needs-driven” service delivery framework. The model is built upon a Response to Intervention (RTI)/Multi-Tiered System of Support (MTSS) three-tier structure and integrates ecological systems theory, social cognitive theory, and the health belief model. Using a quasi-experimental design with propensity score matching (PSM), the intervention’s effectiveness was evaluated on a final matched cohort of 470 students. Difference-in-differences (DID) analysis was then employed to assess the outcomes. The results demonstrate that the tiered intervention significantly reduced the BMI Z-scores of at-risk students compared to the control group. Furthermore, by employing XGBoost and SHAP, the study identified key risk factors, such as cardiorespiratory fitness and baseline BMI, enabling precise and early risk identification. Hierarchical linear models (HLMs) further clarified the multi-level factors influencing intervention outcomes. In conclusion, the DWA-CRISPR tiered model proves to be more effective than traditional approaches, providing a scientific, efficient, and personalized pathway for improving the physical health of primary and secondary school students. Full article

What drives persistent urban–rural tourism satisfaction gaps: whether from promotional over-promising or structural service deficits? This distinction fundamentally determines whether territorial development resources should target marketing sophistication or productive capacity, yet remains empirically unresolved. Text-mining for 33,174 attractions across 349 Chinese cities reveals that both rural and urban destinations systematically under-promise, with description sentiment falling consistently below actual ratings, contradicting the “digital facade” hypothesis. Urban attractions nonetheless generate more positive surprises through superior service delivery (gap = 0.62 vs. 0.55). Sentiment measurement robustness is validated through triangulation of two independent dictionary-based methods ($r=0.58$, $p<0.001$) and cross-paradigm verification using a pre-trained BERT transformer ($\tau =1.000$ ranking stability). SHAP decomposition quantifies the policy implication: controllable service quality indicators, including description quality (23.2%), information richness (30.7%), and price positioning (16.5%), collectively explain over 70% of the variance in satisfaction, while fixed geographic factors (rural classification 14.9% and city-tier 14.7%) account for 29.6%, yielding a controllable-to-geographic ratio of 2.4:1. Propensity score matching with six covariates confirms a 0.074–0.100-point rural penalty persists after controlling for confounders, while non-linear analysis demonstrates that rural attractions face no marginal productivity disadvantage, and the challenge is baseline capacity, not investment efficiency. For policymakers pursuing Sustainable Development Goals 8, 10, and 12 through tourism-led regional strategies, these results mandate redirecting resources from demand-side expectation management toward supply-side infrastructure and workforce development, the true binding constraint on rural competitiveness. Full article

Against the backdrop of global climate change, enhancing urban adaptive capacity to climate shocks has become a critical issue for sustainable urban development. Based on this, this study treats the Climate-Adaptive City Pilot (CACP) policy in China as a quasi-natural experiment and employs a difference-in-differences (DID) approach to empirically evaluate its impact on urban ecological resilience, using panel data from Chinese prefecture-level cities from 2010 to 2023. Heterogeneity and mechanism analyses are further conducted to explore differential policy effects and underlying transmission channels. The results indicate that the Climate-Adaptive City Pilot policy significantly enhances urban ecological resilience, and this finding remains robust after a series of robustness checks, including winsorized regressions, propensity score matching, time placebo tests, and individual placebo tests. Further analysis reveals that the policy effects are more pronounced in cities with lower or higher levels of human capital development, as well as in cities with low to medium water resource endowments. Mechanism analysis suggests that resilient infrastructure investment and green technological innovation constitute the key pathways through which the pilot policy improves urban ecological resilience. From the perspective of urban ecological resilience, this study provides empirical evidence on the effectiveness of climate-adaptive city pilot policies and offers important policy implications for deepening the implementation of climate-adaptive city initiatives, designing context-sensitive adaptation strategies, and improving urban climate adaptation governance mechanisms. Full article

Public organizations in Peru have committed substantial resources to artificial intelligence over recent years, yet evidence on whether these investments produce measurable returns has remained scarce. This study evaluated the causal impact of AI adoption on administrative efficiency across 20 Peruvian national public organizations, using a quasi-experimental design combining Difference-in-Differences with Propensity Score Matching, complemented by XGBoost version 1.7.6, Random Forest, GPT-4, and SHAP explainability analysis. The sample comprised 428 civil servants across treatment and control organizations. Results showed significant efficiency gains as perceived by civil servants through validated Likert instruments: work absenteeism decreased by 9.4%, processing times by 8.7%, and administrative costs by 18.2%, all at p < 0.001 with Cohen’s d ranging from 0.55 to 0.90. The convergence between DiD and PSM estimates supports a causal reading of these effects. Four of five hypotheses were supported. AI delivered comparable efficiency gains regardless of institutional complexity, so H2 was not confirmed. Digital infrastructure significantly moderated AI effectiveness (H3: r = 0.198, p = 0.004). Higher resistance to change was significantly associated with lower efficiency outcomes (H5: r = −0.256, p < 0.001), reinforcing the role of proactive change management as a positive moderator of AI effectiveness. SHAP analysis revealed that training investment, specialized IT personnel, and resistance management together explained 51% of predictive importance, outweighing structural variables such as budget size or geographic location. These findings provide the first systematic causal evidence on AI efficiency in Peruvian public administration and offer actionable benchmarks for comparable middle-income public sectors. Full article

Background/Objectives: The COVID-19 pandemic has brought about significant clinical challenges in regard to digestive systems, as well as causing complications such as pancreatitis and biliary infections. Whether diabetes mellitus (DM) contributes to both an increased risk for these complications and mortality amongst COVID-19 patients remains to be investigated. This study aimed to illuminate any possible outcomes, including pancreatitis, cholangitis, cholecystitis and all-cause mortality, among COVID-19 patients with and without pre-existing type 2 diabetes mellitus (T2DM), using real-world data taken from a multinational electronic health record database. Methods: A retrospective cohort study based upon data taken from the database of the TriNetX Global Collaborative Network was conducted. We included patients from the database who had been diagnosed with COVID-19 from January 2020 to December 2023. Enrolled subjects were divided into two cohorts: COVID-19 patients with pre-existing T2DM who had had at least two medical visits, and those without T2DM. Propensity score matching was performed using 68 baseline variables. Outcomes were evaluated within 90 days following COVID-19 diagnosis, with patients with prior relevant diagnoses being excluded. Risk analyses, Kaplan–Meier survival estimates, and hazard ratios were calculated as the outcomes. Results: The incidence of acute pancreatitis was significantly higher in the DM+ group when compared to the DM– group (Hazard ratio (HR) = 1.307; 95% confidence interval (CI) 1.048–1.630, p = 0.017) and mortality (HR = 1.141; 95% CI 1.102–1.181, p < 0.05) by Kaplan–Meier analysis. Risk of cholecystitis (HR = 1.264; 95% CI 1.042–1.533, p = 0.017) was borderline increased, and cholangitis was not significant (HR 0.847, 95% CI 0.583–1.230) Conclusions: In COVID-19 patients, pre-existing T2DM is independently associated with increased risks of acute pancreatitis and mortality. Full article

Aims: Elevated uric acid (UA) levels correlate with worse heart failure (HF) outcomes, but past studies used single UA measurements. The effect of intra-individual UA fluctuations, beyond mean levels, is unclear. This study assesses the relationship between serum UA variability and adverse clinical outcomes in HF patients. Methods: We analyzed 18,115 HF patients from the SHEBAHEART registry (2009–2025) with at least three UA measurements within three years of diagnosis. UA variability was quantified as the mean deviation (MD) from each patient’s average UA level and divided into quartiles: Q1 (≤−0.69 mg/dL), Q2–Q3 (>−0.69 and <1.53 mg/dL, reference), and Q4 (≥1.53 mg/dL). All-cause mortality was the primary outcome and HF hospitalization was secondary. Cox regression, propensity score matching, and subgroup analyses were used. Results: Over a median follow-up of 4.3 years (IQR 1.6–7.7), 36% of patients were hospitalized for HF and 65.5% died. UA variability showed a graded association with outcomes. Low variability (Q1) was linked to reduced mortality (HR 0.79, 95% CI 0.75–0.83) and HF hospitalization (HR 0.84, 95% CI 0.79–0.90), while high variability (Q4) increased mortality (HR 1.58, 95% CI 1.51–1.69) and hospitalization risk (HR 1.17, 95% CI 1.10–1.25) (all p < 0.001). These associations remained after propensity score matching and across HF subgroups. Conclusions: UA variability is a robust, independent predictor of mortality and HF hospitalization. Serial UA monitoring may enhance risk stratification in HF management. Full article

Background and Objectives: Early risk stratification in acute pancreatitis (AP) remains challenging, particularly for identifying patients who initially appear low-risk but later develop complications. The Modified Endothelial Activation and Stress Index (m-EASIX) reflects endothelial injury and systemic inflammation. This study evaluated the prognostic value of dynamic 48 h m-EASIX assessment for predicting adverse clinical outcomes in AP. Materials and Methods: This retrospective cohort study included adult patients hospitalized with AP between January 2020 and June 2025. Propensity score matching (1:1) was performed using age, sex, BISAP score and etiology. Laboratory parameters were recorded at admission and at 48 h. Adverse outcomes were defined as prolonged hospitalization (≥8 days) and/or pancreatic necrosis, abscess, intensive care unit admission or in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of adverse outcomes. Receiver operating characteristic (ROC) analysis evaluated the predictive performance of m-EASIX and compared it with BISAP and Ranson scores. Results: A total of 258 patients were included in the initial cohort, of whom 93 experienced an adverse clinical course. After propensity score matching, 170 patients remained in the final analysis (85 per group). The 48 h m-EASIX score was independently associated with adverse outcomes in both unmatched and matched cohorts. ROC analysis showed a moderate discrimination for composite outcomes (AUC ≈ 0.76) and a stronger discrimination for hard outcomes (AUC up to 0.867). In all analyses, m-EASIX significantly outperformed BISAP and Ranson scores (DeLong test p < 0.001). Dynamic risk reclassification showed that m-EASIX identified a subgroup of patients initially classified as low-risk by BISAP who later developed adverse outcomes. Conclusions: The dynamic assessment of m-EASIX at 48 h provides additional prognostic information for early risk stratification in AP and may help identify patients at an increased risk of unfavorable clinical courses. Full article

Background/Objectives: Among the antiretroviral therapies (ARTs) recently introduced for people living with HIV (PLWH), the fixed-dose combination of bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF) became reimbursable in Italy in June 2019. Methods: This study evaluated drug utilization, healthcare resource consumption and direct costs among ART-naïve adults initiating B/F/TAF or other non-bictegravir-based regimens, identified from June 2019 to September 2022 within administrative databases of healthcare entities covering approximately nine million citizens. Baseline clinical characteristics at first ART prescription were compared across B/F/TAF-treated patients, those receiving other ART regimens, and non-HIV controls, while treatment outcomes during follow-up were evaluated among PLWH receiving B/F/TAF or other ARTs; healthcare consumption and costs were assessed after propensity score matching within the PLWH cohorts only. Results: Overall, 374 individuals initiated B/F/TAF and 5576 other ARTs. Patients treated with B/F/TAF showed greater adherence and persistence, with multivariate analyses confirming a lower risk of discontinuation or switching (HR = 0.66, 95% CI 0.57–0.76, p < 0.001) and a higher likelihood of adherence (HR = 2.40, 95% CI 1.58–3.64, p < 0.001). After matching, the B/F/TAF group exhibited lower 12-month consumption of non-HIV medications, fewer non-HIV hospitalizations, and reduced total healthcare costs, particularly for non-HIV drug prescriptions compared to other ART users. Conclusions: Overall, B/F/TAF was associated with better treatment continuity and meaningful cost savings. Full article

Background: First-line chemoimmunotherapy (I + C) is the standard of care for advanced non-squamous non-small cell lung cancer (NSCLC) without oncogenic mutation. Bevacizumab has been shown to enhance the efficacy of chemotherapy in non-squamous NSCLC, yet its added value when combined with I + C (I + C + B) remains unclear. To address this gap, we conducted a real-world comparative study and a network meta-analysis to evaluate I + C + B versus I + C in this setting. Methods: This retrospective study included patients with advanced EGFR/ALK-negative non-squamous NSCLC treated with first-line I + C + B or I + C. Propensity score matching (PSM) was employed to balance baseline characteristics between groups. Efficacy endpoints were progression-free survival (PFS) and overall survival (OS). Subgroup analyses examined outcomes by PD-L1 expression, age, metastases, and chemotherapy, among other factors. In parallel, a network meta-analysis of four randomized trials (n = 2026) indirectly compared I + C + B against I + C for PFS, OS, and safety outcomes. Results: A total of 277 patients were included, with 167 (60.3%) receiving I + C + B and 110 (39.7%) receiving I + C. Before PSM, the I + C + B regimen significantly prolonged PFS versus I + C (hazard ratio [HR] = 0.69, 95% CI 0.52–0.92, p = 0.010), with this benefit maintaining post-matching (HR = 0.70, 95% CI 0.49–0.99, p = 0.045). However, OS did not differ significantly between groups in either the pre-PSM (HR = 0.93, 95% CI: 0.67–1.30; p = 0.665) or matched analyses (HR = 0.84, 95% CI: 0.54–1.29; p = 0.421). Subgroup analyses suggested greater PFS benefit from I + C + B among PD-L1-negative, older patients, those with brain metastases or multiple metastatic sites, and in patients receiving specific chemotherapy doublets. The network meta-analysis confirmed a PFS advantage for I + C + B over I + C (HR = 0.84, 95% CI: 0.71–0.98) without an OS benefit (HR = 0.95, 95% CI: 0.79–1.14). Toxicity was higher with I + C + B; rates of grade 3–5 adverse events, serious adverse events, and treatment discontinuation were all significantly increased compared to I + C. Conclusions: In the first-line treatment of advanced EGFR/ALK-negative non-squamous NSCLC, adding bevacizumab to I + C improved PFS but did not translate into an OS gain. Although PFS benefits were observed in certain subgroups, these were accompanied by significantly increased treatment-related toxicities. Our findings suggest that no clear subgroup has been identified where the benefit outweighs the risks, necessitating extreme clinical caution. Full article

Background/Objectives: Severe oral mucositis is widely viewed as a transient toxicity of antineoplastic therapy. Whether its long-term consequences differ between cancers that directly damage the upper aerodigestive tract (cancers of the lip, oral cavity, pharynx [CLOP]) and systemic hematologic malignancies is unknown. The aim of this study was to compare lifetime risks of mortality, dysphagia, malnutrition, respiratory disease, and cardiovascular disease in propensity-score-matched survivors of CLOP cancer versus leukemia with and without a history of ulcerative oral mucositis. Methods: Population-based retrospective cohort study using the TriNetX US Collaborative Network (90 healthcare organizations, >110 million patients). We identified 80,526 adults with a personal history of CLOP cancer (ICD-10-CM Z85.81) and 43,684 with leukemia (Z85.6) from 2005 to 2024. Cohorts were stratified by presence/absence of severe oral mucositis (K12.31 or K12.33 at any time). Separate 1:1 propensity-score matching was performed within each cancer type on age, sex, race/ethnicity, hypertension, diabetes, BMI, ECOG status, and external causes of morbidity. Exposures included documented severe (ulcerative) oral mucositis. Main outcomes and measures were all-cause mortality and incident dysphagia, malnutrition, respiratory disease (J00–J99), influenza/pneumonia (J09–J18), and circulatory disease (I00–I99) after the index date. Results: After 1:1 matching, 4181 CLOP patients with mucositis were compared with 4181 without, and 2508 leukemia patients with mucositis were compared with 2508 without. In CLOP survivors, mucositis was associated with markedly higher lifetime mortality (adjusted HR 1.94, 95% CI 1.87–2.01), dysphagia (HR 3.42, 95% CI 3.28–3.57), malnutrition (HR 2.81, 95% CI 2.66–2.97), any respiratory disease (HR 1.68, 95% CI 1.63–1.73), and influenza/pneumonia (HR 1.79, 95% CI 1.72–1.86). In leukemia survivors, mucositis conferred only modest or null excess risk (mortality HR 1.12, 95% CI 1.05–1.19; dysphagia HR 1.18, 95% CI 1.07–1.30; malnutrition HR 1.24, 95% CI 1.12–1.37; any respiratory disease HR 1.09, 95% CI 1.03–1.15). Conclusions and Relevance: Severe oral mucositis is a powerful, durable prognostic determinant in cancers of the upper aerodigestive tract, where it identifies patients associated with elevated lifelong risk of swallowing dysfunction, aspiration-related lung disease, malnutrition, and premature death. The markedly attenuated effect in leukemia survivors suggests that direct high-dose radiation-induced structural damage to the pharynx and oral cavity—rather than systemic immunosuppression or chemotherapy intensity alone—is the dominant mechanism. Full article

Background: Transarterial chemoembolization (TACE) is an established image-guided, minimally invasive therapy for unresectable hepatocellular carcinoma (HCC). However, post-embolization hypoxia often triggers compensatory angiogenesis and an immunosuppressive microenvironment, limiting long-term efficacy. We hypothesized that the immediate image-guided hepatic arterial infusion (HAI) of a PD-1 inhibitor following TACE could synergistically enhance local tumor control. Methods: In this retrospective, propensity-score-matched study, 226 patients with unresectable HCC (January 2021–June 2024) were analyzed. After 1:1 matching, 84 pairs were included: Study Group (TACE + HAI-nivolumab) and Control Group (TACE alone). Nivolumab (3 mg/kg) was infused via the hepatic artery under fluoroscopic guidance immediately after embolization. Primary endpoints were overall survival (OS) and progression-free survival (PFS); secondary endpoints included objective response rate (ORR) by mRECIST and changes in serum angiogenesis/immune biomarkers. Results: The Study Group demonstrated significantly longer median OS (16.2 vs. 12.8 months; HR 0.62, 95% CI: 0.44–0.88, p = 0.007) and median PFS (9.8 vs. 6.5 months; p < 0.001). ORR was higher with combination therapy (58.3% vs. 36.9%, p = 0.006). Mechanistically, HAI-nivolumab suppressed the post-TACE surge in VEGF and Ang-2 (p < 0.001) and increased the peripheral CD4+/CD8+ T-cell ratio. Grade 3/4 adverse events were comparable between groups (14.3% vs. 10.7%, p = 0.485). Conclusions: The image-guided combination of TACE with immediate HAI of nivolumab is associated with improved survival and tumor response in unresectable HCC. This strategy may counteract the adverse post-embolization microenvironment by simultaneously inhibiting angiogenesis and reactivating local immunity, representing an advanced image-guided combination therapy with strong translational relevance. Full article

Objectives: To evaluate the short-term safety (30-day and in-hospital morbidity and mortality) and technical feasibility of uniportal video-assisted thoracic surgery (U-VATS) for anatomical lung resection in octogenarians (≥80 years) compared with younger patients (<80 years) at a single center. Methods: Ninety consecutive patients undergoing U-VATS anatomical lung resections between January 2020 and January 2024 were retrospectively analyzed. Patients were stratified by age: 60 patients < 80 years and 30 octogenarians ≥ 80 years. Propensity score matching (nearest-neighbor, 1:2 ratio, caliper 0.2 SD) yielded a matched cohort of 60 patients (40 younger, 20 octogenarians) for comparative analysis. Results: After matching, standardized mean differences (SMD) were <0.25 for most covariates, indicating good balance. Octogenarians demonstrated lower FEV1 (75.2 ± 15.3% vs. 87.5 ± 18.2%, p = 0.012) and DLCO (68.4 ± 12.1% vs. 78.5 ± 14.3%, p = 0.009), consistent with age-related pulmonary changes. Charlson Comorbidity Index was higher (5.3 ± 1.2 vs. 3.8 ± 1.4, p = 0.001). Surgical parameters were comparable: operative time (143.80 ± 42.3 vs. 136.55 ± 38.7 min, p = 0.524), blood loss (median 80 [IQR 50–120] vs. 95 [IQR 60–130] mL, p = 0.742). Zero conversions occurred. Major complications (Clavien–Dindo ≥ 3) occurred in 10% vs. 0% (absolute risk difference 10%, 95% CI: −3.2% to 23.2%). No 30-day mortality. 90-day mortality: 5% vs. 0% (p = 0.333); one-year: 15% vs. 0% (p = 0.035). Conclusions: U-VATS is technically feasible in carefully selected octogenarians with comparable intraoperative parameters to younger patients. Postoperative recovery differed meaningfully, with higher delirium rates, longer hospitalization, and greater rehabilitation needs. One-year mortality was higher in octogenarians, reflecting competing comorbid risk rather than surgical harm. Residual imbalance in comorbidity burden and pulmonary reserve after matching limits causal inference. These hypothesis-generating findings support U-VATS in selected octogenarians when comprehensive geriatric assessment and structured delirium prevention guide perioperative management; validation in larger multicenter prospective studies is required. Full article