We conducted a cadaveric feasibility study of two intrapleural applications of single-use bronchoscopes. In Approach 1, a 2.7 mm bronchoscope was used as a visual stylet inside a 20-Fr trocar catheter to confirm pleural entry and drain-tip position. In Approach 2, a 5.0 mm bronchoscope was used as a flexible thoracoscope for limited pleural inspection, aspiration, and direct-vision forceps biopsy; a sprayed-instillation maneuver was performed only to confirm technical deliverability. Approach 1 was attempted and feasible in six hemithoraces of three Thiel-embalmed cadavers. Approach 2 was attempted and feasible in four hemithoraces; it was not attempted in two hemithoraces due to time constraints and a large persistent air leak after Approach (1) No negative-to-positive conversion (new persistent air leak) was observed after Approach (2) These techniques may offer complementary approaches to conventional methods for observing the intrathoracic space and therefore warrant stepwise clinical validation.

The aim of this review was to clarify the differences in therapeutic intent and indications for salvage surgery following treatment with epidermal growth factor receptor tyrosine kinase inhibitor versus definitive chemoradiotherapy. Unresolved issues in molecular targeted therapy, including the optimal surgical procedure, timing of surgical intervention, and the relationship between surgery and radiotherapy, were examined to provide practical guidance for integrating systemic and local treatment in advanced lung cancer. This focused narrative review was developed by conducting a targeted PubMed search through October 2025 using terms associated with epidermal growth factor receptor, tyrosine kinase inhibitors (TKIs), and salvage or conversion surgery. Relevant studies were selectively examined to explore indications, patient selection, timing of surgery, extent of resection, and comparisons with radiotherapy as an alternative local treatment. Salvage surgery following definitive chemoradiotherapy is intended to cure isolated intrathoracic recurrences and typically excludes patients with uncontrolled distant metastases or unresectable lymph node disease. Conversely, salvage surgery following TKI therapy is increasingly included in strategies for systemic disease control. Its objectives include removing local lesions resistant to systemic treatment, prolonging the effectiveness of systemic therapy, and gathering pathological and genomic information. Importantly, the primary therapeutic goal is to prolong overall survival when performed after TKI therapy, rather than improve disease-free survival. As molecular targeted treatments advance, the role of salvage surgery following TKI therapy is expected to expand. Further evidence is required to guide patient selection, timing of intervention, and surgical strategy.

Reduction of bleeding and prolonged air leak (>5 days) following major lung resection remains a challenge. Hemostasis and aerostasis devices can facilitate earlier pleural de-drainage and fast-track. Our objectives were to evaluate the efficacy of TenaTac® (an elastic, adhering patch approved as a medical device) in reducing bleeding and prolonged air leak after major lung resection. This monocentric retrospective case-control study, using prospectively collected data, includes 60 patients who underwent, between 2022 and 2024, minimally invasive robot-assisted lobectomy or segmentectomy: 30 with TenaTac® vs. 30 with other devices. Data were extracted from Epithor, the French national database, with ethics committee validation. Patients characteristics, Index of Prolonged Air Leak, and surgical procedures were similar in both groups (NS). TenaTac® hemostatic benefit was comparable to other devices (p = 0.56). Prolonged air leak rate was significantly lower with TenaTac® (3%) than for control devices (37%) (p = 0.0004). Post-operative air leakage duration was significantly shorter in TenaTac® group than in control group (2.23 ± 2.57 vs. 4.23 ± 3.87 days, p = 0.01). Mean drainage duration and length of stay were both reduced with TenaTac® by 36 hours. No significant difference was observed between the two groups in terms of morbidity (90-day post-operative complications classified as Clavien-Dindo grade>II, p = 0.33), readmission rates (nil), or 90-day mortality (no deaths). Numerous hemostatic or aerostatic devices have been previously evaluated without achieving consensus in the prevention of prolonged air leak. As an absorbable, adherent gelatine patch, TenaTac® significantly reduces the incidence of prolonged air leak after major lung resection.

Studies suggest that non-small cell lung cancer of the superior segment (S6) affects different lymphatic pathways and results in worse prognosis than basal segment tumors. We aimed to compare survival after lobectomy between non-small cell lung cancer in the S6 and basal segments, focusing specifically on pure-solid tumors, which have higher lymph node metastasis rates and worse prognosis. We retrospectively reviewed patients with pure-solid, clinical N0 M0, ≤ 5-cm, lower-lobe non-small cell lung cancer who underwent lobectomy with hilar and mediastinal lymphadenectomy between April 2009 and December 2021. Overall survival, recurrence-free survival and clinicopathological characteristics were evaluated. We categorized 157 patients into S6 (n = 58) and basal segment (n = 99) groups. The 5-year overall survival (66.4% vs. 68.6%, respectively; p = 0.519; hazard ratio, 1.19; 95% confidence interval, 0.70-2.03), and recurrence-free survival (54.8% vs. 65.5%, respectively; p = 0.452; hazard ratio, 1.22; 95% confidence interval, 0.72-2.06) rates were comparable between the S6 and basal segment groups. Multivariable Cox regression analyses indicated that tumor location was not associated with overall or recurrence-free survival. The S6 group showed a higher tendency for visceral pleural invasion compared with the basal segment group. Superior mediastinal lymph node metastasis was pathologically confirmed exclusively in the S6 group (two cases). No significant difference in survival was observed between S6 and basal segment pure-solid non-small cell lung cancer after lobectomy with hilar and mediastinal lymph node dissection.

Segmentectomy is the standard treatment for small peripheral non-small cell lung cancer. While video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery (RATS) are widely used, evidence focusing on complex segmentectomy (CS) is limited. Therefore, we aimed to compare the perioperative outcomes of VATS and RATS for segmentectomy, focusing on CS. We retrospectively reviewed 497 segmentectomies performed at Shinshu University Hospital (January 2020 and February 2025). After excluding cases of thoracotomy, benign tumors, and prior lung resection, 391 patients (268 CS) were included. Propensity score matching (PSM) generated 159 VATS–RATS pairs for all segmentectomies and 99 pairs for CS. The perioperative outcomes and complications were compared. For all segmentectomies, the operative time was longer with RATS (median, 219 vs. 192 min; p < 0.001), whereas blood loss, drainage duration, length of stay, reoperation, and readmission were comparable. Although not significantly different, arrhythmia incidence was less frequent in the RATS group after PSM (1.9% vs. 5.7%; p = 0.077). In CS, RATS had longer operative time (220 vs. 189 min; p < 0.001) but fewer Clavien–Dindo grade ≥ 2 complications (10.1% vs. 20.2%; p = 0.047) and arrhythmia incidences (1.0% vs. 7.1%; p = 0.030). No 90-day mortalities were observed. Despite longer operative times, RATS achieved perioperative outcomes comparable to VATS and was associated with a lower incidence of postoperative arrhythmia, particularly in CS, potentially related to a reduced extent of lung resection.