Abstract

Frank torsion, or lesser atelectasis, of the right middle lobe/lingula may occur after right upper lobectomy/left apical trisegmentectomy. Although some surgeons fix/pex the right middle lobe/lingula to the lower lobe, the necessity for this is unclear.We retrospectively reviewed patients who underwent right upper lobectomy/left apical trisegmentectomy at our institution (2008-2023). We compared patients who underwent fixation vs those who did not. The primary outcomes were incidence of acute torsion within 6 months after surgery and atelectasis on ∼6-month postoperative computed tomography.Of the 497 patients, 438 (88.1%) underwent right upper lobectomy and 143 (28.8%) underwent fixation. Age, sex, race, comorbidities, and operative diagnosis were similar between the pexy and no-pexy groups (P = .20-.93). Thoracotomy approach was more common in the pexy group (64 [44.8%] vs 65 [18.4%], P < .001), whereas chronic obstructive pulmonary disease (69 [19.5%] vs 10 [7.0%], P < .001) was more prevalent in the no-pexy group. On the primary outcomes, there was no difference between the groups in frank torsion (0 [0%] vs 0 [0%]) or any atelectasis (23 [22.5%] vs 64 [22.9%], P = .94). These findings were unchanged in subgroups of patients without chronic obstructive pulmonary disease and with only right upper lobectomy patients. In a multivariate logistic regression model, undergoing fixation was not a significant predictor of atelectasis on 6-month postoperative computed tomography (odds ratio, 0.94; 95% CI, 0.48-1.86; P = .87).Routine fixation/pexy of the right middle lobe/lingula during right upper lobectomy/left apical trisegmentectomy does not reduce rates of postoperative torsion or atelectasis. Although ensuring no malrotation of remaining lobes during lung reexpansion is likely important, the routine practice of pexy, which has downsides, should be abandoned.

View details for DOI 10.1016/j.atssr.2026.03.017

View details for PubMedID 42719613

View details for PubMedCentralID PMC13555389

Abstract

Lung cancer screening (LCS) rates are low despite expanded eligibility criteria. Many patients receiving cardiac CT scans may also have risk factors for lung cancer. We aimed to identify an opportunity to increase LCS by quantifying this population.All patients in our healthcare system from January 2011 to December 2023 who received a CT heart or CT angiogram heart were included. Lung cancer rates in this population were assessed. LCS eligibility was determined by USPSTF guidelines.A total of 31,684 patients received cardiac CT scans and 17,232 patients met the study criteria (documented smoking history, age 50-80 years, no prior diagnosis of lung cancer). Based on 2021 USPSTF guidelines, 114 (0.7%) patients were eligible for LCS compared to 0.37% of all patients in our healthcare system. A total of 73 patients undergoing cardiac CT developed a diagnosis of lung cancer. Among those meeting LCS eligibility, 1 (0.8%) developed lung cancer, 7 (6.1%) received a low dose CT, and 21 (18.4%) received a diagnostic chest CT. An additional 72 (0.4%) patients of patients who received a cardiac CT were subsequently diagnosed with lung cancer at a median of 19.8 (5.7, 51.7) months, yet did not meet LCS eligibility.Risk of lung cancer diagnosis among patients receiving cardiac CT scan is significantly higher than that of the general population. However, most of these patients did not qualify for LCS. Advocacy for more complete chest imaging in this population may facilitate identification of lung cancer for early intervention.

View details for DOI 10.1016/j.athoracsur.2026.08.003

View details for PubMedID 42612958

Abstract

Persistent or slow-growing subsolid nodules and atypical lung cysts often represent indolent forms of lung cancer. These nodules require careful assessment by a multidisciplinary tumor board to determine risk, natural history, treatment options, and patient preferences. When the preferred management is imaging surveillance rather than active intervention, the main objective is to detect significant changes that could alter patient management. The choice of imaging modality should be based on its accuracy and whether the findings will influence the decision to pursue treatment. If the team determines that treatment is necessary, a diagnostic imaging workup and a biopsy are typically indicated and should not be considered part of surveillance. Therefore, this document aims to outline evidence-based guidelines specifically for imaging surveillance of indolent pulmonary nodules in patients for whom the clinical team has chosen to delay intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

View details for DOI 10.1016/j.jacr.2026.07.003

View details for PubMedID 42573542

Abstract

High maximum standard uptake value (SUVmax) is associated with recurrence after NSCLC resection, but whether it should impact the lobectomy vs. sublobar decision for Stage IA adenocarcinoma ≤2cm is unclear. We examined the value of SUVmax in guiding resection strategy.Retrospective single-center review (2005-2024) of clinical Stage IA adenocarcinoma ≤2cm with preoperative PET who underwent lobectomy or sublobar resection. The optimal SUVmax threshold for recurrence-free survival was identified using maximally-selected rank statistics and used to categorize patients into high and low SUV groups. Primary outcomes were recurrence and disease-free survival (DFS); secondary outcomes were overall (OS) and cancer-specific survival (CSS).Among 558 patients (309 lobectomy; 249 sublobar), recurrence occurred in 28 (9.1%) and 34 (13.7%), respectively. The optimal SUVmax cut-off was 3.0. On multivariate analysis, high SUVmax was an independent predictor of recurrence in both the entire cohort [OR: 2.29 (1.17-4.50), p=0.02] and the sublobar group [OR: 3.16 (1.19-8.44), p=0.02]. Among wedge resections alone, high SUV remained an independent predictor of recurrence [OR: 4.18 (1.44-12.48); p=0.01]. In the high SUV group, DFS was inferior after sublobar vs lobar resection (62.5% vs 78.7%; p=0.022), while no DFS difference was seen between procedures among low SUV patients. OS and CSS did not differ by strategy within either SUV category.SUVmax ≥3 independently predicted recurrence after sublobar resection, with findings driven primarily by the wedge resection subgroup. This suggests careful consideration of resection strategy, particularly wedge resection, for Stage 1A tumors with SUVmax ≥3.

View details for DOI 10.1016/j.athoracsur.2026.06.049

View details for PubMedID 42401220

Abstract

Imposter syndrome (IS), the phenomenon of feeling inadequate despite having the qualifications, accolades, and attributes to succeed, is prevalent among physicians in multiple fields. We sought to characterize the prevalence of imposter syndrome and determine its impact among cardiothoracic trainees and early-career surgeons.A multisection survey instrument was distributed to cardiothoracic surgery trainees in the US and early career (EC) cardiothoracic surgeons within their first 7 years after training. The survey included a validated imposter phenomenon scale, instruments to measure social support, to detect burnout, and to assess symptoms of anxiety and depression. Multivariable logistic regression analysis was performed to identify characteristics associated with significant imposter syndrome. Relationships between imposter syndrome and associated conditions were explored using Pearson correlation coefficients.A total of 1048 subjects were contacted; complete responses were received from 143 (13.6%), of which 64 (44.7%) were from trainees and 79 (55.3%) from EC surgeons. Significant imposter syndrome was present in 88 subjects (61.6%) and was more common among trainees than EC surgeons (71.9 vs. 53.2%, p = 0.01). On multivariable analysis, female gender (odds ratio (OR) 6.9, 95% CI, 2.8-19.1; p < 0.01) was predictive of clinically significant IS, while a thoracic training track (OR 0.26, 95% CI, 0.08-0.72; p = 0.03) was protective. There was a positive correlation between IS and anxiety, between IS and foregone career opportunities, and a negative correlation with social support.Imposter syndrome, associated in particular with anxiety symptoms, was common amongst respondent cardiothoracic trainees and early career surgeons. Potential links with gender, training track, social support, and missed career opportunities were identified. Further study of IS, awareness and strategies to mitigate should be considered in cardiothoracic training.

View details for DOI 10.1016/j.jsurg.2026.104004

View details for PubMedID 42250451

Abstract

The development of effective antibody therapeutics has been hampered by a lack of methods to measure drug delivery and activity within tumors at single-cell resolution. Here we introduce single-cell spatial pharmacobiology (SSP), an experimental and analytical framework that integrates in situ imaging of a systemically infused, fluorescently labeled therapeutic antibody with high-plex spatial proteomics to quantify antibody distribution, target engagement and tumor microenvironment (TME) architecture. We applied SSP to tumor tissues from participants with head and neck squamous cell carcinoma and pancreatic ductal adenocarcinoma who received the antibody panitumumab-IRDye800 in phase 1 trials. SSP identified pronounced spatial heterogeneity in single-cell drug delivery and target engagement, shaped by conserved stromal barriers, including periostin-rich extracellular matrix assemblies and fibroblast-activation-protein-positive cancer-associated fibroblast neighborhoods, which were associated with reduced antibody delivery in both tumor types. SSP measures drug-target-TME interactions in human tumors and can support studies of resistance mechanisms, dosing strategies and discovery of spatial biomarkers for precision oncology.

View details for DOI 10.1038/s41587-026-03152-x

View details for PubMedID 42236958

View details for PubMedCentralID 9728470

Abstract

Most data regarding the prognostic value of pulmonary function tests are >10 years old. With increased adoption of minimally invasive surgery and sublobar resection, updated outcomes data are important for counseling higher risk patients considering lung resection.We conducted a retrospective analysis of patients undergoing elective lung resection from 2013-2023. A composite outcome of respiratory complications was defined. Forced expiratory volume in 1 second (FEV1) and diffusing capacity of lung for carbon monoxide (Dlco) were stratified into 20% intervals, and postoperative outcomes were analyzed. Multivariable models incorporating FEV1, Dlco, and relevant patient and operative factors assessed the impact of these variables on respiratory complications, length of stay, and mortality.Of the 1532 patients undergoing pulmonary resection, postoperative respiratory complications occurred in 8.6%, median length of stay was 4 days, and 30-day mortality was 1.1%. Analysis of FEV1 and Dlco intervals showed increased respiratory complications with decreased FEV1 and Dlco, but in multivariable analysis only FEV1 was a significant predictor of complications (P < .001), not Dlco. Higher FEV1 was associated with shorter length of stay, while Dlco was not significant. Mortality was associated with lower FEV1. Minimally invasive surgery mitigated the effects of lower FEV1 on complications.In our study, FEV1 remains a risk factor for postoperative morbidity and mortality, while Dlco is not. Minimally invasive approaches mitigate complications among patients with worse pulmonary function. These findings can assist in counseling patients with marginal pulmonary function considering lung resection.

View details for DOI 10.1016/j.atssr.2025.12.010

View details for PubMedID 42266984

View details for PubMedCentralID PMC13245326

Abstract

Existing methods of grading atelectasis are typically subjective and not scalable. We aimed to develop an automated, deep learning-based framework to quantify and grade postoperative atelectasis. We retrospectively included all patients who underwent RULobectomy from 2008 to 2023. We trained three nnU-Net v2 segmentation models for preoperative and postoperative lobes and airways with volumetric quantification of the right middle lobe (RML), right lower lobe (RLL), and total lung volume. Atelectasis severity in the RML was independently graded using a 5-point radiological scale (none, minimal, subsegmental, segmental, lobar). The association between volume metrics with atelectasis severity and clinical outcomes was evaluated. 236 patients comprised the study cohort. Median(IQR) RML volume loss progressively increased with higher atelectasis grades, from -4.6 mL (-78.5, 59.0) in grade 0 to -317.8 mL (-440.7, -194.8) in grade 4 atelectasis (p < 0.001). Normalized RML/right lung (RL) and RML/total lung (TL) volume ratios showed statistically significant differences across the pooled atelectasis grades (p < 0.001). Normalized RLL volumes increased with worsening RML atelectasis (p < 0.001), suggesting compensatory hyperinflation. A higher ΔRML/RL [OR(95%CI): 0.89 (0.81-0.98), p = 0.01] and ΔRML/TL [0.80 (0.65-0.98), p = 0.03] were associated with reduced 1-year need for bronchoscopy. We demonstrate the feasibility and clinical relevance of deep learning-based volumetric assessment of atelectasis after RULobectomy.

View details for DOI 10.1038/s41746-026-02683-6

View details for PubMedID 42062447

View details for DOI 10.1016/j.jtcvs.2026.03.526

View details for Web of Science ID 001765305700043

View details for DOI 10.1016/j.jtcvs.2026.03.460

View details for Web of Science ID 001765327200067