ABSTRACT Objective: This study aims to evaluate the role of TUSG in the postoperative period and the detection of early complications after surgical treatment, pulmonary resection, or decortication for infectious and inflammatory thoracic diseases, comparing with the standard method (Chest Radiography ‒ CXR). Methods: Prospective non-randomized self-controlled study. Twenty-one patients over 16 years of age have undergone surgical treatment of inflammatory and infectious lung diseases. These patients were followed up with CXR and TUSG (performed on the 1st and 3rd postoperative days and/or after the chest tube removal). Results: Both exams demonstrated similar results regarding their ability to safely predict the adequate moment for chest drain removal. TUSG allowed chest drain removal in 30% of cases and CXR in 34%. Statistical analysis demonstrates that both exams have similar capabilities in detecting postoperative changes in the pleural space. However, the authors report that TUSG is statistically more accurate in detecting subcutaneous emphysema than CXR (p = 0.037, Kappa [κ = 0.3068]). The analysis of other parameters showed no statistical difference. Conclusion: The authors conclude that TUSG in trained hands is equivalent to CXR in searching for postoperative complications regarding the surgical treatment of infectious and inflammatory thoracic diseases and can be used as a complement, and not a substitute, to CXR, when CCT is not feasible, or a more urgent diagnosis is needed. Objective resection Chest CXR. . CXR) Methods nonrandomized non randomized selfcontrolled self controlled Twentyone Twenty one 1 performed st rd andor removal) Results 30 34 34% space However p 0037 0 037 0.037 κ 0.3068. 03068 0.3068 3068 0.3068]) difference Conclusion complement substitute feasible needed 3 003 03 0.03 0306 0.306 306 0.3068] 00 0.0 030 0.30 0. 0.3

ABSTRACT Objective: The purpose of this study was to assess performance in the Brazilian Lung Cancer Registry Database by using the parsimonious EuroLung risk models for morbidity and mortality. Methods: The EuroLung1 and EuroLung2 models were tested and evaluated through calibration (calibration plot, Brier score, and the Hosmer-Lemeshow test) and discrimination (ROC AUCs), in a national multicenter registry of 1,031 patients undergoing anatomic lung resection. Results: The evaluation of performance in Brazilian health care facilities utilizing risk-adjustment models, specifically EuroLung1 and EuroLung2, revealed substantial miscalibration, as evidenced by calibration plots and Hosmer-Lemeshow tests in both models. In terms of calibration, EuroLung1 exhibited a calibration plot with overlapping points, characterized by a slope of 1.11 and a Brier score of 0.15; the Hosmer-Lemeshow test yielded a statistically significant p-value of 0.015; and the corresponding ROC AUC was 0.678 (95% CI: 0.636-0.721). The EuroLung2 model displayed better calibration, featuring fewer overlapping points in the calibration plot, with a slope of 1.22, with acceptable discrimination, as indicated by a ROC AUC of 0.756 (95% CI: 0.670-0.842). Both models failed to accurately predict morbidity and mortality outcomes in this specific health care context. Conclusions: Discrepancies between the EuroLung model predictions and outcomes in Brazil underscore the need for model refinement and for a probe into inefficiencies in the Brazilian health care system. Objective Methods HosmerLemeshow Hosmer Lemeshow AUCs, AUCs , AUCs) 1031 1 031 1,03 resection Results riskadjustment adjustment miscalibration 111 11 1.1 0.15 015 0 15 pvalue p value 0.015 0015 0678 678 0.67 95% 95 (95 CI 0.6360.721. 06360721 0.636 0.721 . 636 721 0.636-0.721) 122 22 1.22 0756 756 0.75 0.6700.842. 06700842 0.670 0.842 670 842 0.670-0.842) context Conclusions system 103 03 1,0 1. 0.1 01 0.01 001 067 67 0.6 9 (9 6360 0.6360.721 0636072 0636 0.63 0721 0.72 63 72 0.636-0.721 12 2 1.2 075 75 0.7 6700 0.6700.842 0670084 0670 0842 0.84 84 0.670-0.842 10 1, 0. 0.0 00 06 6 ( 0.6360.72 063607 063 072 7 0.636-0.72 07 0.6700.84 067008 084 0.8 8 0.670-0.84 0.6360.7 06360 0.636-0.7 0.6700.8 06700 08 0.670-0.8 0.6360. 0.636-0. 0.6700. 0.670-0. 0.6360 0.636-0 0.6700 0.670-0 0.636- 0.670-

Abstract Introduction Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates. Methods Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method. Results Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality. Conclusion Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors. 2 NonSeminomatous Non Seminomatous (NSGCT chemotherapy longterm long term 201 2022 KaplanMeier Kaplan Meier method Thirtyseven Thirty seven 318 31 8 31. years Twentytwo Twenty two pathologies 6 types 405 40 5 40. each 70.3 703 70 3 (70. group 39.2 392 39 (39. 37.2 372 37 (37. %, , cervicosternotomy cervico 9.8 98 9 (9. 5.8 58 (5. 3.9 (3. . cases Overall 10year year 10 943 94 94. surgicalrelated related mortality tumors 202 4 70. 7 (70 39. (39 37. (37 9. (9 5. (5 3. (3 1 (7 (

Abstract Background Lung lymphatic drainage occurs mainly through a peribronchial path, but it is hypothesized that visceral pleural invasion could alter this path. This study aims to investigate the association between visceral pleural invasion, node upstaging, and N2 skip metastasis and the impact on survival in a population of patients with non-small cell lung cancer of 3 cm or smaller. Methods We retrospectively queried our institutional database of lung cancer resection for all patients with clinical stage IA NSCLC between June 2009 and June 2022. We collected baseline characteristics and clinical and pathological staging data. Patients were classified into two groups: The non-VPI group with negative visceral pleural invasion and the VPI group with positive. The primary results analyzed were the occurrence of nodal upstaging, skip N2 metastasis and recurrence. Results There were 320 patients analyzed. 61.3 % were women; the median age was 65.4 years. The pleural invasion occurred in 44 patients (13.7 %). VPI group had larger nodules (2.3 vs. 1.7 cm; p < 0.0001), higher 18F-FDG uptake (7.4 vs. 3.4; p < 0.0001), and lymph-vascular invasion (35.7 % vs. 13.5 %, p = 0.001). Also, the VPI group had more nodal disease (25.6 % vs. 8.7 %; p = 0.001) and skip N2 metastasis (9.3 % vs. 1.8 %; p = 0.006). VPI was a statistically independent factor for skip N2 metastasis. Recurrence occurred in 17.2 % of the population. 5-year disease-free and overall survival were worse in the VPI group. Conclusions The visceral pleural invasion was an independent factor associated with N2 skip metastasis and had worse disease-free and overall survival. path upstaging N nonsmall non small smaller 200 2022 data groups nonVPI positive recurrence 32 613 61 61. women 654 65 4 65. years 13.7 137 13 7 (13. %. . %) 2.3 23 2 (2. vs 17 1 1. 0.0001, 00001 0.0001 , 0 0001 0.0001) 18FFDG FFDG 18F FDG F 7.4 74 (7. 3.4 34 lymphvascular lymph vascular 35.7 357 35 (35. 135 5 13. 0.001. 0.001 001 Also 25.6 256 25 6 (25. 87 8 8. 9.3 93 9 (9. 18 0.006. 0006 0.006 006 0.006) 172 17. 5year year diseasefree free 20 202 (13 2. (2 0000 0.000 000 7. (7 3. 35. (35 0.00 00 25. (25 9. (9 (1 ( (3 0.0 0.

Abstract Objective: This study aims to correlate the RAPID score with the 3-month survival and surgical results of patients undergoing lung decortication with stage III pleural empyema. Methods: This was a retrospective study with the population of patients with pleural empyema who underwent pulmonary decortication between January 2019 and June 2022. Data were collected from the institution’s database, and patients were classified as low, medium, and high risk according to the RAPID score. The primary outcome was 3-month mortality. Secondary outcomes were the length of hospital stay, readmission rate, and the need for pleural re-intervention. Results: Of the 34 patients with pleural empyema, according to the RAPID score, patients were stratified into low risk (23.5 %), medium risk (47.1 %), and high risk (29.4 %). The high-risk group had a 3-month mortality of 40 %, while the moderate-risk group hada 6.25 % and the low-risk group had no deaths within 90days, confirmingagood correlation with the RAPID score (p < 0.05). Sensitivity and specificity for the primary outcome in the high-risk score were 80.0 % and 79.3%, respectively. The secondary outcomes did not reach statistical significance. Conclusions: In this retrospective series, the RAPID score had a good correlation with 3-month mortality in patients undergoing lung decortication. The morbidity indicators did not reach statistical significance. The present data justifies further studies to explore the capacity of the RAPID score to be used as a selection tool for treatment modality in patients with stage III pleural empyema. Objective 3month month 3 Methods 201 2022 institutions institution s database stay rate reintervention. reintervention re intervention. intervention re-intervention Results 23.5 235 23 5 (23. , %) 47.1 471 47 1 (47. 29.4 294 29 4 (29. %. . highrisk moderaterisk moderate 625 6 25 6.2 lowrisk 90days days p 0.05. 005 0.05 0 05 0.05) 800 80 80. 793 79 79.3% respectively significance Conclusions series 20 202 23. 2 (23 47. (47 29. (29 62 6. 00 0.0 8 7 79.3 (2 (4 0. 79. (

Abstract Background and objective This study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects. Materials and methods The authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023. Results 463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications. Conclusion Bedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety. aspects 202 2023 46 20 period 1styear styear 1st year st USG. USG . (USG) smallbore small bore complications training pointofcare point care safety 4 2 (USG

ABSTRACT Bronchial anastomotic complications are a cause of grave concern for surgeons that perform lung transplantations. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding adequate exposure and manipulation of the bronchial stump and anastomosis. Here we report the use of Octopus™ Tissue Stabilizer as a mean to allow for a better exposure of the stump and facilitate a “no-touch” approach towards anastomosis. Systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of bronchial anastomotic complications. transplantations complication them anastomosis Octopus notouch no touch “no-touch