Endovascular aneurysm repair (EVAR) has markedly reduced perioperative morbidity and mortality in the management of abdominal aortic aneurysms. However, its long-term durability remains a concern because of sac expansion, endoleaks, and late rupture. Sac shrinkage serves as a key surrogate marker of procedural success, reflecting favorable remodeling and a lower risk of complications. Sac behavior after EVAR is determined by the interplay between intrasac pressure and aneurysm wall integrity. Although pressure reduction is essential, wall degeneration and stiffness critically influence remodeling outcomes. The presence of simple renal cysts, a localized manifestation of systemic connective tissue degeneration, has been associated with impaired sac shrinkage and may indicate unfavorable remodeling. Arterial stiffness, assessed by pulse wave velocity, also correlates with sac behavior: lower stiffness favors shrinkage, whereas higher stiffness is linked to expansion or lack of shrinkage. These findings suggest that sac remodeling is a multifactorial process not solely dependent on flow exclusion. Future prospective studies integrating artificial intelligence, vascular remodeling inhibition, and stent graft innovation are warranted to refine patient-specific risk stratification, guide individualized surveillance, and promote sac shrinkage, thereby improving outcomes after EVAR.

Purpose: Although immune checkpoint inhibitor-based perioperative therapy has become the standard for resectable stage IIIA-N2 non-small cell lung cancer (NSCLC), not all patients are eligible for this approach. This study evaluated long-term outcomes of histology-based induction chemoradiotherapy (CRT) followed by surgery.

Methods: This prospective observational study enrolled 48 consecutive patients with pathologically confirmed stage IIIA-N2 NSCLC between April 2010 and May 2025. Patients with squamous cell carcinoma (Sq) received cisplatin/vinorelbine, while those with non-squamous cell carcinoma (non-Sq) received cisplatin/pemetrexed, both with concurrent radiotherapy (50 Gy), followed by surgery.

Results: All 48 patients (25 Sq, 23 non-Sq) completed induction CRT; 45 (93.8%) underwent surgery, with 97.8% achieving complete resection. Median follow-up was 48.8 months. The 5-year overall survival/disease-free survival (DFS) rates were 77.9%/77.3% for Sq and 70.5%/33.7% for non-Sq cohorts. Grade 3/4 toxicities were more frequent in Sq patients (80.0% vs. 21.7%, p <0.001). Exploratory analysis revealed inferior DFS in epidermal growth factor receptor (EGFR)-mutated non-Sq patients, though overall survival remained favorable with subsequent tyrosine kinase inhibitor therapy.

Conclusion: Histology-based induction CRT followed by surgery demonstrated feasibility and favorable outcomes, particularly for Sq and EGFR-negative non-Sq NSCLC. These findings provide a reference for patients ineligible for immune checkpoint inhibitor-based therapy.

Purpose: Aortoesophageal fistula (AEF) after esophagectomy is a rare but catastrophic complication, often occurring after anastomotic leakage and mediastinal contamination. Evidence regarding fatal trajectories and rescue failure points remains limited.

Methods: We performed a retrospective, single-center study among esophageal cancer patients who developed AEF after esophagectomy between 2013 and 2024. Cases were identified from institutional databases and mortality records, followed by manual screening. Clinical course, antecedent complications, diagnostic workup, rescue interventions, and causes of death were summarized descriptively.

Results: Among 5543 esophagectomies, 17 patients (0.31%) developed AEF: 16 fatal (94.1%) and 1 survivor (5.9%). All were male, median age 63 years. Anastomotic leak occurred in 16 patients (94.1%), all with mediastinal infection. Sentinel bleeding preceded hemorrhage in 14 patients (82.4%); the median interval to fatal hemorrhage was 1 day.

Conclusions: Post-esophagectomy AEF is highly lethal. Sentinel bleeding represents a critical intervention window. Prompt recognition and multidisciplinary escalation may enable survival even in high-risk patients.

Purpose: The optimal method of pericardial closure in lung transplantation remains controversial. This study aimed to evaluate the technical feasibility and procedural simplicity of pericardial closure using donor pericardium.

Methods: We retrospectively reviewed 70 adult patients who underwent deceased-donor bilateral lung transplantation with cardiopulmonary bypass or central extracorporeal membrane oxygenation between December 2010 and January 2024 at Kyoto University Hospital. Patients were divided into the Donor pericardium group (n = 21) and the Autologous tissue group (n = 49). Pericardial closure time was assessed as an indicator of procedural simplicity, and postoperative complications within 1 year were descriptively evaluated.

Results: Baseline characteristics did not differ between the groups. Mean pericardial closure time was significantly shorter in the Donor pericardium group than in the Autologous tissue group (13 ± 2.4 vs 19 ± 1.6 min, P = 0.03). No clinically concerning differences in postoperative complications were observed during short- to mid-term follow-up.

Conclusion: Pericardial closure using donor pericardium enables technically simpler and faster closure without apparent short-term safety concerns.

Purpose: Malignant cardiac tumors are rare and have a poor prognosis. Surgical resection is performed for symptom relief and survival benefit, but its efficacy is limited. We reviewed our 20-year single-institution experience with primary and metastatic malignant cardiac tumors.

Methods: We retrospectively reviewed 15 patients who underwent resection for histologically confirmed malignant cardiac tumors between 2006 and 2025. Data included tumor characteristics, resection status, and survival outcomes.

Results: Of 15 patients, 7 (46.7%) had primary tumors (most common: angiosarcoma) and 8 (53.3%) had metastatic lesions. The right atrium was the most frequent site (60.0%). Complete (R0) resection was achieved in only 3 cases (20.0%). Median overall survival (OS) for the cohort was 11 months. Patients with angiosarcoma had particularly poor outcomes (median OS: 5 months). One patient with metastatic thymic carcinoma achieved long-term survival (>15 years) following multimodal therapy. Adjuvant therapy was administered in 7 patients (46.7%). No 30-day postoperative mortality occurred.

Conclusion: Surgical resection of malignant cardiac tumors is feasible with acceptable perioperative safety. Although R0 resection is rarely attainable and long-term outcomes remain poor, particularly for high-grade sarcomas, a multimodal approach is essential to optimize outcomes in selected patients.

Purpose: Silent cerebral infarctions are common after aortic arch surgery; however, the predictive value of preoperative computed tomography (CT)-derived plaque characteristics remains unclear. We investigated the incidence, distribution, and risk factors for new cerebral infarction lesions (NCILs) after total aortic arch replacement (TAR), focusing on low-attenuation plaque (LAP, 0–60 Hounsfield units [HU], a surrogate of lipid-rich vulnerable plaque) burden.

Methods: Among 82 consecutive TAR patients, 41 underwent both pre- and postoperative brain diffusion-weighted magnetic resonance imaging (MRI). Clinical profiles, CT-derived atheroma grade and plaque attenuation, operative details, and outcomes were compared between NCIL-positive and NCIL-negative groups. The primary multivariable model simultaneously included arch atheroma grade and LAP area, adjusted for age and sex.

Results: NCILs were detected in 25/41 patients (61%): 23 silent and 2 symptomatic. All NCILs exhibited embolic imaging features without watershed or hypoperfusion patterns. NCIL-positive patients had significantly greater arch LAP area (63.9 vs. 17.7 mm², p <0.01). On multivariable analysis, arch LAP remained the only independent predictor (OR per 10 mm², 3.01; 95% confidence interval [CI] 1.50–8.75; p = 0.012), whereas atheroma grade was not.

Conclusion: More than half of TAR patients developed MRI-detected, predominantly silent NCILs. Preoperative arch LAP was the sole independent predictor. LAP assessment may refine intraoperative risk stratification and guide tailored neuroprotective strategies.

Purpose: Conventional monitoring of serum creatinine at isolated time points is suboptimal for reflecting disease progression. We therefore evaluated the prognostic value of distinct serum creatinine trajectories for predicting all-cause mortality in this patient population.

Methods: We conducted a retrospective cohort study of elderly patients undergoing cardiac surgery, using data from the Medical Information Mart for Intensive Care database (MIMIC-IV). Kaplan–Meier analysis compared survival outcomes among the identified classes. Multivariable logistic and Cox proportional hazards models determined the independent associations of these trajectories with in-hospital and 1-year all-cause mortality.

Results: A total of 5145 patients undergoing cardiac surgery were included in the analysis. Three distinct creatinine trajectories were identified: low-stable (Class 1), persistent-increase (Class 2), and transient-increase (Class 3). Class 1 had the lowest in-hospital and 1-year mortality rates. Using Class 1 as the reference, Class 2 demonstrated the highest mortality risk, followed by Class 3.

Conclusion: Distinct creatinine trajectory patterns conferred independent prognostic value for postoperative outcomes in elderly patients after cardiac surgery. A persistently high trajectory was independently associated with significantly increased mortality compared to the low-stable trajectory class.

Purpose: Lung resection is a standard treatment for localized lung cancer, but prolonged air leakage is a common complication with health and economic burdens. Interventions such as staplers, sealants, and adjunctive materials are used, yet real-world data describing their utilization remain limited.

Methods: Using a hospital database with claims and discharge summaries from 393 hospitals in Japan, we identified patients undergoing lobectomy, segmentectomy, or partial resection for primary lung cancer between 2015 and 2020. We evaluated intraoperative use of staple-line buttresses, fibrin glue, polyglycolic acid (PGA) sheets, and other materials. Patient characteristics and comorbidities were compared across material-use categories, and the incidence of prolonged postoperative drainage (≥7 days) was assessed.

Results: Among 33094 lobectomy, 5443 segmentectomy, and 8242 partial resection patients, buttress use was uncommon (2.2%, 3.5%, and 6.4%). Patients receiving buttresses or PGA plus fibrin glue had higher prevalences of emphysema and interstitial pneumonia than those in the stapler-only group. Prolonged drainage remained frequent (6.9% in stapler-only vs. 24.8% in buttress among lobectomy patients) and was associated with nearly doubled postoperative in-hospital costs.

Conclusions: Prolonged air leakage remains a major complication following lung resection, associated with clinical and economic burden. This study provided a nationwide overview of real-world utilization patterns of adjunctive materials.

Purpose: The present study reviewed surgical cases of lung cancer associated with cystic airspace (LCCA) and examined the imaging and clinicopathological features of these cases.

Methods: A total of 75 patients with lung cancer associated with cystic airspace, who underwent lung cancer surgery in our hospital between January 2017 and December 2020, were included. We retrospectively analyzed the association between postoperative recurrence of lung cancer and lung cancer associated with the cystic airspace using the Cox proportional hazards model.

Results: Patients with LCCA had a worse prognosis than those with non-LCCA. Furthermore, a univariate analysis showed a significant difference between sex, smoking, differentiation, tumor size, Stage, and LCCA, while a multivariate analysis showed a significant difference between Stage and LCCA. LCCA cases were classified into four categories, as reported in a previous study. Types I and III showed more adenocarcinomas, while Type IV tended to show squamous cell carcinomas.

Conclusions: LCCA has a poor prognosis. It is often difficult to determine which of the T factors of the TNM classification are applied. Therefore, further studies are needed to accumulate more LCCA cases.

Purpose: A decrease in peripheral basophil count has recently been suggested as a potential marker of poor prognosis in malignancies. This study aimed to determine the optimal cutoff value for basophil count and assess its clinicopathological and prognostic significance in esophageal squamous cell carcinoma (ESCC).

Methods: We retrospectively analyzed 194 patients with ESCC (157 men, 37 women; mean age, 67 years [range, 34–88]) who underwent curative surgery between 2010 and 2020, including 100 who received neoadjuvant chemotherapy. Receiver-operating characteristic curve analysis identified an optimal basophil cutoff value of 17.4/μL. Patients were divided into low- and high-basophil groups, and clinicopathological factors and prognosis were assessed using univariate and multivariate analyses.

Results: Low-basophil counts were significantly correlated with low neutrophil counts but not with C-reactive protein level. Multivariate analysis to predict overall survival identified deep invasion, elevated C-reactive protein, and low-basophil count as independent predictors of a poor prognosis (P <0.05).

Conclusion: Low preoperative basophil count is an independent adverse prognostic factor in ESCC. As basophil count was not correlated with C-reactive protein, it may provide prognostic value beyond conventional inflammation-based markers and could represent a simple, low-cost biomarker to aid risk stratification in the preoperative setting.

Purpose: Research regarding Custodiol’s safety in minimally invasive mitral valve repair remains limited in Asian populations. We compared Custodiol in minimally invasive mitral valve repair to repetitive cold blood cardioplegia in open mitral valve repair.

Methods: We retrospectively evaluated 98 consecutive patients who underwent minimally invasive mitral valve repair with Custodiol and 70 consecutive patients who underwent open mitral valve repair with repetitive cold blood cardioplegia at our institution between January 2015 and December 2024. The primary endpoints were creatine kinase-myocardial band (MB) levels and left ventricular ejection fraction determined by echocardiography pre- and post-surgery.

Results: Maximum creatine kinase-MB levels within 48 h post-surgery were significantly lower in the minimally invasive group than in the open repair group, both in the overall cohort (45.0 vs. 60.7 U/L; p <0.001, respectively) and after excluding patients who underwent Maze procedure or pulmonary vein isolation (42.4 vs. 50.0 U/L; p = 0.009, respectively). Left ventricular ejection fraction pre- and post-surgery was comparable between the minimally invasive and open repair groups (72% vs. 69%; p = 0.426 and 59% vs. 60%; p = 0.204, respectively).

Conclusion: Custodiol during minimally invasive mitral valve repair provides myocardial protection comparable to repetitive cold blood cardioplegia in open mitral valve repair.

Purpose: Central airway adenoid cystic carcinoma (CAACC) is a rare malignancy lacking a standard treatment approach and often precluding complete resection. This study assessed the surgical outcomes of patients with CAACC treated at a single institution.

Methods: We retrospectively reviewed patients who underwent surgical resection for CAACC between September 2013 and August 2021.

Results: Eight patients (mean age: 51.5 years) were included. Tumor locations were bronchus (n = 1), trachea (n = 4), carina and bronchus (n = 2), and carina and trachea (n = 1). Surgical procedures included sleeve lobectomy (n = 1), tracheal resection (n = 4), sleeve pneumonectomy (n = 2), and carinal resection with reconstruction (n = 1). Preoperative radiation and bronchoscopic tumor resection were performed in 1 patient each. One patient died from a postoperative tracheoinnominate artery fistula. Major complications included recurrent laryngeal nerve palsy (n = 3). Adjuvant therapy was provided for positive or uncertain margins. During a median follow-up of 6 years, 2 patients developed recurrence but remained alive at the last follow-up. The 5-year overall survival rate was 72.9%.

Conclusion: Surgical resection with airway reconstruction and adjuvant therapy can offer long-term disease control in CAACC, though life-threatening complications warrant careful consideration.

Purpose: This study aimed to evaluate sex-based differences in the clinical characteristics, aortic anatomy, surgical strategies, and outcomes of patients undergoing emergency surgery for acute Stanford type A aortic dissection (AAAD).

Methods: We retrospectively analyzed 148 consecutive patients (82 males and 66 females) who underwent surgery for AAAD at a single center. We compared their backgrounds, entry tear locations, operative procedures, and postoperative outcomes. Kaplan–Meier analysis assessed long-term survival and freedom from re-intervention.

Results: Female patients were significantly older than male patients, more likely to have ascending aortic entry tears, and more often treated by hemiarch replacement. Male patients underwent total arch replacement more frequently because of arch or distal entry tears and had a higher incidence of iliac artery involvement, indicating more extensive distal dissection. In-hospital mortality, major postoperative complications, long-term survival, and freedom from re-intervention showed no significant sex-based differences.

Conclusion: In female patients, the predominance of ascending entry tears allows less extensive surgery without compromising outcomes. Therefore, when dissection patterns are suitable, emergent surgery is appropriate even in elderly female patients.

Purpose: This study aimed to assess perioperative features, early postoperative outcomes, and mid-term cardiac function in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) undergoing surgical repair.

Methods: A retrospective review of 23 patients treated surgically between 2007 and 2023 was conducted. Patients were categorized into infants (<1 year) and older patients (>1 year). Clinical, operative, and echocardiographic data were analyzed, including left ventricular ejection fraction (LVEF) and mitral regurgitation (MR). Follow-up evaluations were performed at 1 and 6 months postoperatively.

Results: The median age at surgery was 9 months. Early mortality occurred in 17.4%, with no late deaths during follow-up. Preoperative LVEF was significantly lower in infants than in older patients (p = 0.013). Among 19 survivors, LVEF improved markedly by 1 month and normalized in all patients by 6 months. MR was present in 89.5% preoperatively, with 47.3% showing moderate to severe grades. At 6 months, MR improved in most cases, with only 2 patients exhibiting residual moderate regurgitation and no severe cases.

Conclusions: ALCAPA is a rare but surgically correctable condition. Early surgical intervention leads to significant recovery of ventricular function and regression of MR within the first 6 postoperative months.

Purpose: The internal thoracic artery (ITA) has shown increased production of nitric oxide, which has beneficial effects on ventricular remodeling, among conduits of coronary artery bypass grafting (CABG). However, little is known about the impact of bilateral ITA strategy on postoperative left ventricle (LV) reverse remodeling as compared with single ITA, especially in patients with severely impaired LV function.

Methods: We retrospectively reviewed 126 propensity-matched patients with advanced ischemic cardiomyopathy (ICM) (left ventricular ejection fraction <40%) who underwent isolated multiple CABG utilizing bilateral (BITA group; n = 65) or single (SITA group; n = 61) ITA. The primary endpoint was postoperative reduction in the indexed left ventricular end-systolic volume index (LVESVI). Baseline covariates were adjusted with propensity score-matching.

Results: At baseline, there were no intergroup differences in LVESVI (78 vs. 78 ml/m², P = 0.93) and EuroSCORE II score (3.0% vs. 2.8%, P = 0.70). At 6 months post-surgery, the BITA group reduced LVESVI to a greater degree than the SITA group (−33% vs. −17%, P <0.01), resulting in significantly smaller postoperative LVESVI (49 vs. 63 ml/m², P = 0.03). Multivariable analysis showed that CABG with BITA (P = 0.011) was associated with postoperative LV reverse remodeling.

Conclusion: In patients with ICM undergoing CABG, the in situ BITA strategy was associated with greater reductions in postoperative LV volume.

Purpose: The superior segment (S6) may differ from the basal segments (BSs) in lymphatic spread, affecting surgical strategy and mediastinal lymph node dissection (LND). We aimed to define lymphatic spread patterns and to guide surgical strategy in S6 non-small cell lung cancer (NSCLC).

Methods: We reviewed 375 patients with cT1a–cT1c N0 lower-lobe NSCLC (S6, 168; BS, 207) who underwent segmentectomy or lobectomy (2012–2024). We analyzed nodal metastasis and recurrence by station.

Results: Segmentectomy was more frequent in S6 than in BS. pN1 and pN2 incidence was 8.3% and 2.4% in S6 and 4.3% and 6.8% in BS, respectively. In S6, pN2 metastases were single-station with N1, with no inferior mediastinal involvement. S6 nodal recurrences were confined to #4L/#4R and occurred outside the LND field. In BS, skip pN2 was more frequent and nodal recurrences occurred at #7 within the field.

Conclusion: In clinical stage IA S6 NSCLC, nodal events occurred in the superior mediastinal stations. All pN2 were single-station with N1, and all nodal recurrences occurred after lobe-specific mediastinal LND. Management should follow intraoperative N1 assessment: if negative, S6 segmentectomy without mediastinal LND; if positive, lobectomy with superior mediastinal and subcarinal LND, omitting inferior mediastinal nodes unless specifically suspected.

Purpose: Pulmonary vein stump thrombus (PVST) is a relatively common complication after left upper lobectomy that can cause vital organ embolism. We previously found that patients with PVST on postoperative day 7 show risky hemodynamic features around the pulmonary vein stump on 4-dimensional (4D) flow magnetic resonance imaging (MRI), which may contribute to thrombus development. However, it remains unclear whether such hemodynamics persist later.

Methods: Eleven patients who underwent left upper lobectomy for lung cancer received 4D flow MRI on postoperative day 7 and again after over 3 months. Hemodynamic parameters were used to classify each case as risky or non-risky for PVST.

Results: According to a total of 24 examinations in 11 patients, 7 were classified as risky and 17 as non-risky. PVST developed in 6 patients during various postoperative phases, and all PVST cases developed under the risky conditions. Furthermore, PVST did not develop under non-risky conditions, suggesting that our risk assessment is valid as a predictive marker for PVST.

Conclusion: Our results suggest that late postoperative hemodynamic assessments, as well as early postoperative assessments, are useful for identifying patients at high risk of PVST. A late postoperative hemodynamic assessment may contribute to determining when to discontinue anticoagulants.

Purpose: Surgery for Jehovah’s Witness patients with Stanford type A aortic dissection (TAAD) carries a high surgical risk, and few reports have examined outcomes in this patient population. This study evaluated perioperative outcomes of surgery for TAAD in Jehovah’s Witness patients.

Methods: Eight Jehovah’s Witness patients who underwent surgery for TAAD at our institution between February 2016 and January 2025 were retrospectively reviewed. No patients were receiving antiplatelet or anticoagulant therapy at the time of surgery. Preoperative characteristics, operative data, and postoperative outcomes were assessed.

Results: Emergency ascending aortic replacement was performed in 6 patients, while the 2 patients who underwent elective surgery due to a chronic course or thrombosed false lumen received total or partial arch replacement. Both elective cases received preoperative iron supplementation. The median postoperative nadir hemoglobin was 9.2 (interquartile range, 6.8–9.6) g/dL. One patient died, one was transferred to rehabilitation, and 6 patients (75.0%) were discharged home without major complications.

Conclusions: Perioperative outcomes of surgery for TAAD in Jehovah’s Witness patients were favorable. Proper surgical timing and preoperative management are essential to achieving satisfactory results. Further investigation with a larger cohort and longer follow-up is warranted.

Primary cardiac intimal sarcoma is an extremely rare, high-grade malignancy characterized by rapid progression and high early recurrence rates. We report the case of a 28-year-old male who underwent emergency resection for a large left atrial intimal sarcoma (10 × 8 cm). Follow-up imaging at 6 months revealed a 15-mm recurrent tumor infiltrating the left atrial septum, despite an initially stable recovery. We prioritized radical resection over surgical risk, given the patient’s youth and the aggressive behavior of the tumor. Therefore, a “Commando” procedure consisting of radical tumor resection, double valve replacement, and reconstruction of the intervalvular fibrosa using the Manouguian technique was performed. Histopathological examination confirmed recurrent intimal sarcoma with negative surgical margins. Despite its high invasiveness, the Commando procedure is viable for primary treatment for recurrent cardiac intimal sarcomas in young patients. Aggressive surgical reconstruction remains the only viable option to improve the prognosis of this otherwise fatal malignancy.

Tracheomediastinal fistula is a rare but potentially life-threatening complication associated with malignant lymphoma. We report a case of spontaneous closure of a tracheomediastinal fistula that developed after chemotherapy for mediastinal diffuse large B-cell lymphoma (DLBCL). A 70-year-old man presented with airway compression caused by a large mediastinal tumor. After airway stabilization with a Dumon Y stent and subsequent R-CHOP chemotherapy, the tumor markedly regressed. Following stent removal, a fistula developed in the anterior tracheal wall, communicating with a necrotic mediastinal space. Because no clinical or laboratory signs of mediastinitis were observed, conservative management without antibiotics or invasive intervention was adopted. The fistula gradually decreased in size and closed completely within 10 weeks. This case suggests that tracheomediastinal fistulas without mediastinitis may be managed conservatively under careful observation. Treatment strategies should be individualized based on anatomical location and the presence or absence of infection.

Post-tuberculosis airway stenosis can cause fixed cicatricial narrowing and long-term disability. We report a female patient with recurrent upper tracheal restenosis despite 2 prior resections, who presented decades later with respiratory failure; intubation was impossible, necessitating emergency tracheostomy. Imaging and bronchoscopy revealed pinhole stenosis near the second tracheal ring and left main bronchial stenosis with a destroyed left lung. The patient remained tracheostomy-dependent and aphonic after infection control. Because repeat resection was high-risk and endoscopic stent delivery was infeasible, a Dumon silicone stent was inserted via transcervical longitudinal tracheotomy under direct vision. Airway patency and phonation improved, and follow-up showed a stable stent without major complications. This open approach may serve as a salvage surgery when endoscopic delivery is impossible.

Interrupted aortic arch (IAA) is a rare congenital anomaly usually diagnosed in infancy and associated with intracardiac defects, making survival into adulthood without repair exceptional. We report the case of a 62-year-old woman with longstanding hypertension who presented with progressive dyspnea and dysphagia. Computed tomography angiography identified a type B IAA associated with a giant 96-mm aneurysm arising from an aberrant retroesophageal artery connecting the right subclavian artery to the descending thoracic aorta, without associated cardiac abnormalities. Surgical management consisted of isolated resection of the aneurysmal segment and placement of a 14-mm Dacron graft, without reconstruction of the aortic arch given the patient’s age and stable hypertension. The postoperative course was uneventful, and follow-up imaging showed stable repair with complete symptom resolution. This case highlights the possibility of long-term survival without restoration of normal aortic anatomy, and suggests that a tailored, complication-focused surgical approach may be appropriate in selected adult patients.

Giant cell tumor of bone (GCTB) rarely metastasizes, but pulmonary lesions pose therapeutic challenges. We report a woman in her 30s who developed multiple bilateral lung nodules 3.5 years after distal ulna GCTB resection and local recurrences. Denosumab 120 mg every 4 weeks was given for 2.5 years, producing shrinkage, calcification, and stability. Staged, palpation-guided thoracoscopic wedge resections (8 left, 5 right) achieved complete macroscopic clearance with negative margins. Histology showed spindle-cell proliferation with woven bone and depletion of giant cells; H3.3 G34W immunostaining confirmed metastatic GCTB. She remains recurrence-free 7 years and 5 months after metastasectomy. Denosumab displayed site-specific surgical implications—unfavorable at the primary bone site due to peritumoral sclerosis, yet advantageous in the lung where it clarifies margins and enables parenchyma-sparing R0 resection. A surgery-forward strategy that uses time-limited denosumab as a bridge to meticulous thoracoscopic metastasectomy may secure durable control in multifocal pulmonary GCTB.