Background: Up to now, no study has described the long-term survival and its prognostic factors of robotassisted sleeve lobectomy. Here, the present cohort study reported the long-term oncologic outcomes of robot-assisted sleeve lobectomy to evaluate the oncological feasibility of sleeve lobectomy via a robotic surgical system in patients with centrally located non-small cell lung cancer (NSCLC).Methods: A total of 104 consecutive patients with centrally located NSCLC who underwent robot-assisted bronchial single sleeve lobectomy between October 2014 and May 2021 were retrospectively reviewed.Bronchial single sleeve lobectomy only refers to the resection and end-to-end anastomosis reconstruction of the bronchus, without the resection of the pulmonary vessels or carina. The recurrence status during followup, 5-year overall survival (OS) and disease-free survival (DFS) were assessed.Results: In the total cohort, 47 (45.2%) patients had pathological stage I disease, 28 (26.9%) patients had pathological stage II disease, and 29 (27.9%) patients had pathological stage III disease. Recurrence occurred in 26 (25.0%) patients, including locoregional recurrence in 10 (9.6%) patients and distant recurrence in 16 (15.4%) patients. No endobronchial nor perianastomotic recurrence was detected. The Kaplan-Meier curves indicated that the 5-year DFS and OS rates in the cohort were 67.9% and 73.0%, respectively. In terms of pathological stages, the 5-year DFS and OS rates were 82.9% and 82.2% for stage I patients, 57.8% and 69.7% for stage II patients, and 54.5% and 63.7% for stage III patients, respectively.Multivariable analyses demonstrated that higher pathological stage or N2 stage were independent risk factors for poorer DFS and OS.Conclusions: Robot-assisted bronchial single sleeve lobectomy could be an oncologically adequate procedure for patients with centrally located NSCLC, due to the long-term survival was similar to that reported for video-assisted thoracoscopic surgery (VATS) or open technique. Further studies of comparative studies or high-quality randomized controlled trials are required.

We present a case of surgical management of a tracheoesophageal fistula (TEF) following prolonged intubation. After transverse tracheal division and retraction of the distal stump, direct closure of the esophageal defect and repair of the membranous tracheal defect using a synthetic bioabsorbable patch were performed, followed by interposition of muscle flap between the suture lines and tracheal reconstruction. Large TEFs, without tracheal stenosis or circumferential airway defect, associated with marked peritracheal inflammation, may be treated with this alternative tracheoplastic technique in patients deemed not suitable for tracheal resection and anastomosis.

We report an unusual mediastinal recurrence along descending thoracic aorta during oncologic follow-up in a 47-year-old female smoker issued by lung adenocarcinoma with a history of left lower lobectomy and lingulectomy en bloc followed by adjuvant chemotherapy for stage III A-N2. Regional recurrence occurring along the staple line was suspected and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined to PET/CT allowed to reach definitive tissue diagnosis. High focal hypermetabolic activity on PET/CT at the site of suspect recurrence was necessary to check the lesion sampling by EBUS-TBNA.

We report successful surgical management of post-intubation tracheoesophageal fistula (TEF) in an adult patient requiring long-term mechanical ventilation. A complete tracheal transection without tracheal resection, via an anterior cervical approach, followed by direct closure of tracheal and esophageal defect, and interposition of muscle flap between the suture lines and tracheal reconstruction was performed. In selected cases, this surgical procedure may be a viable alternative to traditional techniques used to treat post-intubation TEF via the anterior or lateral cervical approach.

Alectinib is a highly selective tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK) that is approved as first-line treatment in adult patients with ALK-positive non-small cell lung cancer (NSCLC) and as second-line in patients previously treated with crizotinib, and has been shown in the literature to significantly prolong progression-free survival compared to chemotherapy in patients with advanced non-small cell lung cancer. The authors describe a clinical case of a 24-year-old woman with malignant massive pleural effusion caused by ALK rearranged pulmonary adenocarcinoma with pleural and pericardial metastasis, in which, despite a dramatic clinical debut, the correct and timely management of the diagnostic and therapeutic path allowed for extraordinary therapeutic success.