Search Results (579)

Background/Objectives: To evaluate the diagnostic potential of apparent diffusion coefficient (ADC) values for classifying lymph nodes as benign or malignant in breast cancer patients undergoing [¹⁸F]FDG-PET/MRI staging. Methods: Mean ADC values and short-axis diameters (±standard deviation) of 199 thoracic lymph nodes in 113 newly diagnosed breast cancer patients were retrospectively analyzed. All patients underwent [¹⁸F]FDG-PET/MRI staging, between July 2017 and June 2021. A node-by-node comparison was performed with respect to pathological node status. Nodal FDG uptake in whole-body [¹⁸F]FDG-PET/MRI served as reference standard for nodal malignancy. Group comparison using Mann–Whitney U test, receiver operating characteristic curve (ROC) analysis and diagnostic performance were calculated. p values below 0.05 were defined as statistically significant. Confidence intervals (CI; 95%) were calculated. Results: Ninety-three lymph nodes were FDG-negative while 106 lymph nodes were FDG-positive. FDG-negative lymph nodes had significantly lower short-axis diameters ((5.1 ± 1.5 mm versus 12.3 ± 5.3 mm); p < 0.01; U: 405.50; Z: −11.24). ADC values were significantly lower in FDG-positive lymph nodes (0.72 ± 0.14 × 10⁻³ mm²/s) than in FDG-negative lymph nodes ((1.18 ± 0.18 × 10⁻³ mm²/s); p < 0.01; U: 173.00; Z: −11.80). ROC analysis and Youden’s index revealed an ADC cut-off of 0.95 × 10⁻³ mm²/s (AUC: 0.98; p < 0.01; 95% CI: 0.96–1.01). According to the calculated cut-off, sensitivity, specificity, and accuracy of ADC values for differentiating FDG-negative from FDG-positive lymph nodes were 98%, 97% and 97%, respectively. Conclusions: ADC values derived from MRI were significantly associated with FDG uptake in this retrospective cohort and may serve as a complementary imaging biomarker for lymph node characterization. Full article

Thin-slice high-resolution computed tomography (CT) has improved the detection of small pulmonary nodules, increasing the demand for minimally invasive diagnostic and therapeutic resection. While lobectomy with lymph node dissection remains the standard surgical approach for many patients with resectable non-small cell lung cancer, accumulating evidence supports sublobar resection for selected small, peripheral, and ground-glass-dominant lesions when sufficient margins are achievable. In thoracoscopic and robotic surgery, localization of nodules ≤10 mm or lesions located >5 mm from the pleural surface can be challenging, and failure to identify the target may lead to conversion, larger resection than intended, or prolonged operative time. Several localization strategies have been developed, including CT-guided percutaneous wire/coil/dye marking, bronchoscopic dye mapping, and virtual-assisted lung mapping (VAL-MAP), robotic-assisted bronchoscopic dye or fiducial localization, radiofrequency identification microtag systems (Surgical Real-Time FInger Navigation and Detection) that provide real-time depth information, and single-stage intraoperative CT-guided marking and resection in hybrid operating rooms. This review synthesizes representative evidence and published outcome ranges, and compares workflows, marker-to-lesion precision metrics, complication profiles, operational burden, and cost structures. We emphasize the practical contrast between two-stage and single-stage workflows, the access-route differences between transthoracic and transbronchial techniques, and the need to report localization-to-incision “time at risk”. We also present an expert-consensus decision algorithm aimed at facilitating tailored selection of localization strategies for modern minimally invasive thoracic surgery. Full article

Background/Objectives: To evaluate the prognostic significance of automated, volumetric body composition analysis (BCA) derived from pretreatment thoracic computed tomography (CT) scans in patients with head and neck cancer (HNC). Methods: We retrospectively assessed 160 patients (median age: 63 years; 26.9% women) undergoing primary treatment. BCA quantified various tissue volumes, including bone (B), skeletal muscle (SM), and subcutaneous adipose tissue (SAT). Optimal sex-specific cutoffs for BCA metrics were established via maximally selected log-rank tests. Internal validation of BCA cutoffs was conducted via bootstrap resampling. Kaplan–Meier survival analysis and Cox proportional hazards modeling were used to investigate progression-free survival (PFS). Results: The median PFS for all patients was 51.7 months (95% confidence interval (CI): 31.4–68.8). Among the continuous BCA parameters, only SM/B was significant across the total cohort (hazard ratio (HR): 0.23; 95%CI: 0.12–0.46; p < 0.0001, males (p = 0.0009), females (p = 0.004)). Internal validation of gender-specific cutoffs demonstrated strong-to-intermediate stability for SM/B across both sexes and for SAT/B in males. In contrast, SAT/B exhibited only weak stability among female participants. In univariate PFS analysis, dichotomized SM/B, SAT/B, Union for International Cancer Control (UICC) stage, Eastern Cooperative Oncology Group (ECOG) status, higher body mass index (BMI), normal albumin, and Charlson Comorbidity Index were identified as significant predictors of PFS. Multivariable analysis identified high SM/B (HR: 0.53; 95% CI: 0.3–0.93; p = 0.026) and high SAT/B (HR: 0.58; 95% CI: 0.35–0.95; p = 0.029) as independent prognostic factors, alongside lower UICC stage (p = 0.045) and lower Charlson Comorbidity Index (p = 0.038). Patients with high SM/B and SAT/B ratios had the longest median PFS (65.9 months, 95%CI: 51.7–.), compared to 36.4 months (95%CI: 19.4–.) for high SM/B or SAT/B and 12.6 months (95%CI: 4.2–25.1) for low SM/B and SAT/B (p < 0.0001). Conclusions: Although the BCA parameters SM/B and, to a lesser extent, SAT/B appear to be promising biomarkers, external validation and investigation within well-defined patient subgroups are warranted to establish their generalizability in clinical practice. Full article

Esophageal cancer remains a global challenge, with poor overall survival despite advances in multimodal therapy. Surgical resection continues to be the main curative treatment, yet esophagectomy is among the most technically challenging oncological procedures due to the esophagus’s location within the densely packed mediastinal corridor. Critical vascular, neural, and lymphatic structures surround the esophagus, and their frequent anatomical variations pose significant risks during mobilization, lymphadenectomy, and reconstruction. This review synthesizes current evidence on the anatomical variability in the vessels, nerves, lymphatics, and fascial compartments relevant to esophageal surgery. Particular emphasis is placed on aberrant arterial and venous patterns, recurrent and non-recurrent laryngeal nerve pathways, thoracic duct variants and atypical courses, and the fascial planes that are used to define surgical boundaries. By shifting the surgical paradigm from standardized anatomical assumptions to patient-specific structural mapping, we highlight how understanding these variations is driving the field of personalized surgical medicine. By integrating these anatomical insights with surgical approaches—including right and left transthoracic, transhiatal, and transcervical techniques—we highlight the implications of variations for intraoperative safety and postoperative outcomes. A thorough understanding of these relationships is essential for surgical planning, minimizing morbidity, and achieving oncological outcomes. Ultimately, a thorough understanding of these relationships is essential for patient-tailored surgical planning. Full article

Background/Objectives: Management of cervical esophageal cancer after induction therapy remains unsettled. Definitive chemoradiotherapy is the guideline default, but a subset of patients with residual but resectable disease may still benefit from surgery. No validated multidisciplinary selection framework exists for this subsite. Methods: We conducted a systematic review registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261369102) and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, using searches of PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library from inception through 14 April 2026. We identified 1779 records, removed 873 duplicates, and screened 906 records; 87 full-text reports were assessed, of which 67 were excluded at the full-text stage (66 on population grounds—disease not cervical esophageal; and 1 because cervical-direct outcomes were not separable within a mixed cervical/thoracic cohort), leaving 20 cervical-direct studies included in the primary synthesis. Thoracic and meta-analytic sources are cited for indirect comparison and biological rationale but are not counted in the included set. Included studies were evaluated using the Newcastle–Ottawa Scale (NOS) and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I); certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Formal meta-analysis was not performed because study design, treatment approach, and outcome reporting were too heterogeneous. Results: Cervical-specific evidence is predominantly retrospective but consistent in direction. Available cervical-specific observational data suggest benefit mainly in patients with biopsy-confirmed incomplete response, resectable residual disease, preserved performance status, and access to experienced centers. Larynx-preserving resection is feasible in 90% of T1–2 tumors and 54% of T3–4 responders. In thoracic esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy yields pathologic complete response rates of approximately 29–48%; in cervical disease, the SCENIC trial has reported interim clinical response of approximately 50% in 28 patients, but pathology-confirmed response is not yet available. We present a proposed multidisciplinary selection framework integrating response depth, post-induction stage, laryngeal preservation feasibility, sarcopenia, circulating tumor DNA dynamics, and programmed death-ligand 1 (PD-L1) expression. The framework has not been prospectively validated and is presented as a hypothesis-generating, conceptual tool for multidisciplinary discussion rather than a clinically validated instrument. Adjuvant nivolumab is recommended for residual pathologic disease after margin-negative (R0) resection when surgery follows preoperative chemoradiotherapy; after PD-1-based induction, adjuvant checkpoint inhibition remains investigational. Conclusions: The available cervical-direct evidence is predominantly retrospective and selection-prone, and several inputs supporting the framework are extrapolated from thoracic ESCC cohorts; conclusions about the survival benefit of surgery should therefore be read as associations rather than causal claims. Surgery has a role after induction therapy in carefully selected incomplete responders. The proposed framework is designed for multidisciplinary use and requires prospective validation before routine clinical application. Full article

Background: RET fusion is an actionable tumor-agnostic biomarker, but its observed frequency in routine comprehensive genomic profiling (CGP) may vary across testing platforms and clinical contexts. We conducted a nationwide descriptive analysis to benchmark observed RET fusion frequency in Japanese routine practice. Methods: This retrospective descriptive study used anonymized aggregated data from the Center for Cancer Genomics and Advanced Therapeutics (C-CAT), including CGP-tested cases through 31 March 2025. Observed RET fusion frequency was summarized overall, across five standardized CGP platforms, across 12 prespecified organ groups, and in pooled tissue-based versus liquid-based comparisons. Exact binomial 95% confidence intervals were calculated to provide descriptive precision for low-frequency estimates. Results: Among 97,343 cases, 257 were RET-positive, corresponding to an overall observed RET fusion frequency of 0.26%. Platform-specific frequencies were 0.29% (192/66,992) for FoundationOne CDx, 0.28% (42/14,878) for FoundationOne Liquid CDx, 0.14% (6/4235) for GenMineTOP, 0.16% (15/9196) for NCC oncopanel, and 0.10% (2/2042) for Guardant360. Thoracic tumors showed the highest observed frequency (1.39%, 94/6740), followed by head and neck/thyroid tumors (1.04%, 42/4030). In a crude pooled comparison not adjusted for organ mix or clinical context, tissue-based and liquid-based CGP yielded numerically similar crude pooled frequencies of 0.265% (213/80,423) and 0.260% (44/16,920), respectively. Conclusions: This nationwide analysis benchmarks how RET-positive findings are surfaced to clinicians across heterogeneous routine CGP implementations in Japan. The data support platform-aware interpretation of RET results in practice, but should not be construed as biologic prevalence estimates or comparative assay performance. Full article

Background: Direct comparisons between uniportal robotic-assisted (uRATS) and uniportal video-assisted (uVATS) thoracoscopic anatomical lung resection for non-small cell lung cancer (NSCLC) remain scarce. We compared oncologic radicality and perioperative outcomes between the two uniportal approaches in a single-center contemporaneous cohort. Methods: This retrospective cohort study included 56 consecutive NSCLC patients undergoing uniportal anatomical resection between January 2024 and December 2025 (uRATS, n = 12; uVATS, n = 44). The primary endpoint was oncologic radicality of lymph-node dissection (stations sampled, total nodes, mediastinal sampling, R0 rate). Secondary endpoints included operative time, blood loss, pain, recovery metrics, and a composite textbook outcome. Comparisons used Mann–Whitney U and Fisher’s exact tests. Results: Complete (R0) resection was achieved in all 56 patients. The operating surgeon dissected more lymph nodes in the uRATS group (median 13 vs. 7; p = 0.049), with a trend toward more mediastinal stations sampled (4 vs. 3; p = 0.061). Operative time was longer with uRATS (220 vs. 135 min; p < 0.001), but air-leak duration (0 vs. 2 days; p < 0.001), hospital stay (2 vs. 3 days; p = 0.022), and discharge pain (p = 0.017) all favored uRATS. Textbook outcome was achieved in 83% versus 48% (p = 0.047). Conclusions: In a uniportal-experienced unit, uRATS showed comparable intraoperative oncologic-quality metrics to uVATS with directional perioperative-recovery differences favoring uRATS. Larger multicenter studies with longer follow-up are warranted. Full article

Lung cancer remains the leading cause of cancer-related mortality worldwide despite advances in screening, navigational bronchoscopy, and systemic therapies. Diagnostic and therapeutic limitations persist, including uncertainty regarding intraprocedural tissue adequacy during biopsy sampling and constraints of existing ablative modalities for tumors located near critical thoracic structures. This review examines two emerging technologies: Full-Field Optical Coherence Tomography-based Dynamic Cell Imaging (DCI) and monopolar biphasic Pulsed Electric Field (PEF) ablation as complementary emerging technologies that may address these gaps. The Van Gogh™ Microscopy System (CellTivity Scientific, Inc.) utilizes DCI to enable real-time visualization of cellular metabolic activity without tissue destruction, providing functional information regarding tissue viability and microstructural morphology. The Aliya^® PEF ablation system (Galvanize Therapeutics, Inc.) delivers biphasic high-voltage electrical pulses that induce non-thermal tumor cell death while preserving extracellular matrix architecture, potentially allowing treatment near sensitive thoracic structures such as airways, vasculature, and pleura. Early preclinical studies and initial clinical experience suggest that DCI can facilitate rapid intraprocedural assessment of biopsy adequacy, while PEF ablation may provide reproducible focal tumor destruction with a favorable safety profile near critical structures. Although the current evidence base remains limited to early-phase studies and feasibility trials, the convergence of real-time biologic tissue assessment with structurally preserving ablation technologies introduces the possibility of integrating diagnostic confirmation and local therapy within a single procedural workflow. This review summarizes the mechanistic rationale, emerging evidence, and potential clinical applications of these technologies and proposes a conceptual “See and Strike” framework within these two emerging technologies. The methodological limitations, workflow considerations, and future research directions required to validate this approach are also discussed. Prospective multicenter trials and long-term oncologic outcomes will be necessary before widespread clinical adoption. Full article

Background/Objectives: Prolonged air leak (PAL) remains a common complication after lung resection and may delay postoperative recovery and subsequent treatment. This study aimed to identify clinical factors associated with PAL after robot-assisted thoracic surgery (RATS) and to explore potential nonlinear relationships using restricted cubic spline (RCS) modeling. Methods: A retrospective cohort of 1185 patients who underwent RATS for primary lung cancer was analyzed. Multivariable Firth logistic regression was used to identify independent predictors of PAL (≥5 days). A nomogram was constructed based on the final model and internally validated using 1000 bootstrap resamples; its clinical utility was assessed using decision curve analysis. RCS analysis was performed to evaluate potential nonlinear associations. Results: A total of 98 patients (8.3%) developed PAL. Male sex was independently associated with increased PAL risk (OR 3.29, p < 0.001), whereas higher FEV1 was associated with reduced risk (OR 0.50 per 1-L increase, p < 0.001). BMI showed a modest protective effect (OR 0.91, p = 0.01). Age was not significant in the linear model (p = 0.86), but RCS analysis demonstrated a significant nonlinear association, with increased risk at older ages. The nomogram demonstrated moderate discrimination (apparent C-statistic 0.670, optimism-corrected 0.644) and good calibration, with decision curve analysis confirming net clinical benefit over treat-all and treat-none strategies. Conclusions: Male sex and impaired pulmonary function are key predictors of PAL after RATS. Nonlinear modeling revealed complex age-related risk patterns not captured by conventional approaches. The proposed nomogram may assist in preoperative risk stratification and perioperative decision-making. Full article

Immunotherapy with immune checkpoint inhibitors (ICIs) has profoundly transformed the therapeutic landscape of lung cancer. Although ICIs are generally associated with a more favorable toxicity profile compared with traditional chemotherapy, rare and potentially severe immune-related adverse events (irAEs) may occur, sometimes posing significant diagnostic challenges. We report a case of macrophage activation syndrome (MAS) following a single administration of the anti-PD-L1 antibody atezolizumab in a patient with advanced non-small-cell lung cancer (NSCLC). A 62-year-old woman was diagnosed in February 2024 with stage IIIB NSCLC according to the 8th TNM classification. The patient was deemed ineligible for radiotherapy because of previous thoracic irradiation for breast cancer. First-line therapy with carboplatin plus pemetrexed was administered from March to June 2024, resulting in stable disease; this was followed by pemetrexed maintenance from July to October 2024, at which time thoracic disease progression was documented. Second-line treatment with atezolizumab was initiated in November 2024. Ten days after the first infusion, the patient was admitted to the emergency department for fever and confusion. Laboratory investigations revealed markedly elevated C-reactive protein and hyperferritinemia. Despite empirical antibiotic therapy, fever and thrombocytopenia persisted. Bone marrow biopsy demonstrated findings consistent with MAS. Corticosteroid therapy with prednisone at 1 mg/kg was promptly initiated under rheumatologic supervision, leading to a rapid clinical and biochemical improvement. During tapering, inflammatory markers relapsed when prednisone was reduced to below 12.5 mg/day. Given the occurrence of a grade 4 (CTCAE v5.0) immune-related adverse event, atezolizumab was permanently discontinued. The patient remains in follow-up without radiological evidence of disease progression. This case highlights the diagnostic challenge of MAS secondary to ICIs, which may initially present with nonspecific symptoms such as fever, confusion, and elevated inflammatory markers. Early recognition and timely initiation of high-dose corticosteroids were essential for effective management and full recovery. Clinicians should maintain a high index of suspicion for MAS among rare but severe hematologic irAEs during immunotherapy. Full article

Background/Objectives: Stage III non-small cell lung cancer (NSCLC) is a heterogeneous and clinically challenging disease. Despite therapeutic advances, decisions regarding resectability and treatment sequencing remain complex. Multidisciplinary discussion (MDD) is increasingly recognized as key to personalized, evidence-based care. Methods: The “Integrate 6.0” conference gathered approximately 90 lung cancer specialists, including oncologists, thoracic surgeons, and radiation oncologists, divided into mixed groups simulating multidisciplinary team (MDT) meetings. Groups reviewed complex clinical cases, supported by facilitators providing concise, evidence-based updates. A pre-event survey explored MDT structure and dynamics across institutions. Results: The survey highlighted considerable variability in MDT composition and practices. Most participants had significant involvement in thoracic oncology. Discussions revealed higher consensus in straightforward cases, while complex stage III scenarios—especially with driver mutations or bulky nodal disease—required more nuanced, collaborative decision making. Key topics included neoadjuvant chemoimmunotherapy, surgery in borderline resectable cases, and managing immune-related toxicities. Conclusions: “Integrate 6.0” effectively connected theoretical knowledge with real-world practice through interactive, multidisciplinary dialogue. It underscored the vital role of MDD in managing complex stage III NSCLC and the need for adaptable treatment strategies. Future conferences should assess MDD’s impact on outcomes and expand participation to include molecular pathologists and geriatricians. Full article

Background/Objectives: Magnetic resonance imaging (MRI) provides a non-invasive means for a comprehensive assessment of the effect of radiation therapy (RT) on heart function. This study aims to determine RT induced cardiotoxicity in thoracic cancer patients using cardiac MRI. Methods: Cardiac MRI was performed at baseline and at six months post-treatment in patients undergoing standard-of-care RT for lung or esophageal cancers at a single institution. Parameters included regional myocardial strain in the longitudinal, circumferential, and radial directions as well as myocardium T1, T2, and extracellular-volume (ECV) maps. Cardiac segmental doses were extracted from the RT planning scans. The relationship between changes in segmental MRI parameters at six months and segmental heart RT dose were investigated. Results: Twelve patients underwent baseline MRI and four completed the follow-up MRI. Five of the segmental strain parameters showed notable changes between baseline and six-month follow-up. Increased doses in the heart base and apex were associated with moderate-to-large and mild deteriorations, respectively, in strain for all regions. Increased doses in the mid-ventricular regions were associated with improved strain in all regions. The segmental analysis revealed that myocardial regions nurtured by the left coronary artery are more negatively affected by radiation compared to those nurtured by the right coronary artery. Conclusions: Alterations in regional tissue and strain parameters on MRI vary according to local myocardial RT dose, suggesting there may be heterogeneity of radiation sensitivity for the heart substructures and regions. Changes in segmental strain parameters may reflect post-RT cardiac remodeling, but larger confirmatory studies are required. Full article

Thoracic malignancies are uniquely positioned for the integration of emerging technologies such as artificial intelligence (AI), which have the potential to advance precision oncology across the cancer care continuum. In cancer screening, AI has emerged as a promising strategy to enhance diagnostic accuracy, efficiency, and scalability. Deep learning applied to pathology (pathomics) and imaging (radiomics) has enabled the development of novel, noninvasive tools capable of predicting histologic and molecular features that may correlate with treatment response or toxicity. In drug discovery, computational approaches can analyze large-scale genomic, chemical, and clinical datasets to accelerate target identification and match candidate compounds to available targets; this may be particularly useful in the context of resistance to targeted therapy. AI tools may also support treatment planning for radiation and surgery, guide systemic therapy selection, and facilitate continuous monitoring for early identification of treatment resistance or toxicity. As these technologies are integrated into clinical workflows, careful attention to ethical, regulatory, and clinical governance frameworks will be essential to ensure equitable implementation and bias mitigation. Maintaining human oversight and a human-centered approach remain critical, as complex treatment decisions and sensitive patient interactions are central to the care of patients with thoracic malignancies. Full article

Introduction: The management of resectable non-small cell lung cancer has long relied on a relatively limited set of determinants, primarily anatomical resectability and pathological stage. Although these parameters remain central to therapeutic planning, accumulating clinical and translational evidence indicates that they do not fully explain variability in outcomes observed after lung cancer surgery. The primary aim of this review is to evaluate whether current evidence supports the need for a novel heuristic framework in resectable NSCLC. Secondary aims are to examine how host-related, clinical, and data-driven factors contribute to prognosis and treatment selection beyond conventional staging systems. Methods: This review integrates evidence from clinical studies, national registries, and translational analyses to examine how these dimensions contribute to prognosis and treatment selection. Results: Over the past two decades, advances in surgical techniques, perioperative management, systemic therapies, and large-scale clinical databases have revealed additional determinants of prognosis beyond tumor burden, including physiological reserve, nutritional condition, systemic inflammatory state, comorbidities, and socioeconomic environment. Developments in multimodal strategies and minimally invasive surgery have reshaped the therapeutic landscape. Data-driven approaches have identified clinically meaningful subgroups not captured by conventional staging systems. Conclusions: A heuristic framework integrating tumor biology, patient characteristics, and treatment context may better reflect the complexity of contemporary thoracic oncology practice. Full article

Background and Objective: This study aimed to identify preoperative and intraoperative factors associated with thoracic complications after bilateral diaphragmatic stripping during cytoreductive surgery for advanced ovarian cancer. Materials and Methods: A retrospective observational study was conducted at the Gynecologic Oncology Unit of the National Cancer Institute “G. Pascale”, Naples, Italy. We included patients who underwent bilateral diaphragmatic stripping between July 2023 and October 2025. Demographic, surgical, and anesthesiologic parameters were recorded. Univariate logistic regression was performed, and a restricted multivariate model including only variables significant at univariate analysis was used to assess predictors of thoracic complications. Results: Forty-seven patients were analyzed, 10 (21%) of whom developed postoperative thoracic complications. Patients with thoracic complications had a higher body mass index (median 28.4 kg/m², IQR 26.4–29.3 vs. 23.9 kg/m², IQR 22.8–27.3; p = 0.003) and higher ASA scores (p = 0.033). In univariate analysis, ASA (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.12–17.94, p = 0.046) and BMI (OR 1.45, 95% CI 1.14–2.02, p = 0.009) were significantly associated with thoracic complications. In multivariate analysis, only BMI remained an independent predictor (OR 1.599, 95% CI 1.13–2.68, p = 0.027). Conclusions: Elevated BMI was independently associated with an increased risk of thoracic complications after bilateral diaphragmatic stripping in cytoreductive surgery for ovarian cancer. Careful perioperative management and preventive strategies should be considered in overweight patients. Full article