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Introduction Neuroendocrine tumours of the thymus are extremely rare, with an estimated incidence of about 1 in 5 million people. Although data is limited, complete surgical resection remains the most significant prognostic factor for improved survival and disease-free outcomes, with adjuvant radiotherapy playing a role in cases where resection margins are close. This case report details the management of a cortisol secreting pT1bN0 atypical carcinoid of the thymus in a 43-year-old male. Case report 43-year-old male presented with Cushing’s syndrome and was diagnosed with a cortical secreting atypical carcinoid of the thymus. He underwent a robotic thymectomy. Recurrent disease on a DOTATATE-PET CT scan resulted in a second surgery involving complete resection of the mediastinal tumour which had invaded the pericardium, as well as wedge resection of the lung and lymph node sampling. This was followed by adjuvant radiotherapy due to close proximity of the lesion to the margin (< 3 mm).  Discussion Although paraneoplastic syndromes such as Cushing’s syndrome are rare manifestations of thymic neuroendocrine tumours and can result in challenging diagnoses, it is vital to have a high index of suspicion towards ectopic ACTH secretion in order to facilitate timely initiation of multimodal disease management for these patients including surgery and radiotherapy. Conclusion Surgical management has been shown to offer the greatest prognosis in terms of overall survival and disease-free survival. Adjuvant radiotherapy plays a role where resection margins are close.

Introduction Thymomas and thymic carcinomas are rare anterior mediastinal tumours, accounting for 0.2–1.5% of all cancers. Surgical resection is key to treatment, though invasion of surrounding structures like great vessels can complicate this. This case report details the management of a type B3 thymoma (T4 N0 M0) in a 41-year-old male. Case report A 41-year-old male presented with myasthenic symptoms and was diagnosed with a large thymic mass involving the brachiocephalic vein and superior vena cava. After 4 cycles of neoadjuvant chemotherapy, partial resection was performed, followed by radiotherapy. Residual disease led to a second surgery, during which tumour resection and vascular reconstruction using cardiopulmonary bypass were successfully completed. Postoperative recovery was uneventful. Discussion Complete resection, including re-resection, when necessary, is crucial for improved outcomes in thymoma patients. Even with great vessel invasion, aggressive surgery, coupled with chemotherapy and vascular reconstruction, can achieve good survival outcomes. Conclusion Multimodal management, including chemotherapy, complete resection, and vascular reconstruction, offers the best prognosis for invasive thymomas, even with great vessel involvement.

Abstract OBJECTIVES Mediastinitis is an infection affecting the mediastinum, often caused by cardiovascular or thoracic surgery procedures. Management entails antibiotic therapy, surgical debridement, drainage of infected sites and immediate or delayed closure. Negative pressure wound therapy is useful in cases of delayed sternal closure. Several approaches for mediastinal drainage have been proposed, but there is no consensus on the thoracic intervention approach. METHODS A single-centre, retrospective analysis from the UK analysed data from 19 patients who underwent surgical management for mediastinitis between September 2015 and April 2023. Our primary aim was to describe the outcomes from our series where we predominantly employed an open surgical approach. RESULTS The mean age of our cohort was 49 ± 17.12 years old; the mean performance status (PS ECOG) was 2 ± 0.77. Two people were known smokers (10.53%), while five were non-smokers (26.31%). Fifteen patients underwent an open operation (78.85%), with rest undergoing a minimally invasive approach. The majority of procedures were undertaken from the right-hand side. The overall intensive care unit admission rate was 68.42% (n = 13) with an in-hospital complication rate of 5.26% (n = 1). This was a respiratory arrest secondary to mucous plugging. There were no in-hospital deaths, and median follow-up was 41 months (22–50). Overall survival at 3 years was 85%. CONCLUSIONS Open thoracotomy remains an important surgical strategy in the management of complex mediastinitis, but further validation is required through larger, prospective studies. Mediastinitis is a rare but life-threatening condition that may result from deep sternal wound infection (DSWI), oesophageal perforation or descending necrotizing mediastinitis (DNM) [1]. GRAPHICAL ABSTRACT

To compare postoperative outcomes between hydrogel-coated chest drains (HCDs) and conventional non-coated drains (NCDs) in patients undergoing general thoracic surgery, using a propensity score-matched analysis. This retrospective multi-institutional study included adult patients who underwent thoracic surgery across 4 European centres between February and September 2022. Patients were grouped according to drain type (HCD vs NCD), and a propensity score-matched analysis was performed to account for 16 preoperative and intraoperative covariates. The primary outcome was length of postoperative hospital stay (LOS). Secondary outcomes included in-hospital complications, intensive care unit (ICU) admission, chest drain reinsertion, readmission, duration of drainage, and in-hospital mortality. Subgroup analysis was performed in patients undergoing anatomical lung resections. A total of 773 patients were included (HCD n = 362; NCD n = 411). After matching, 724 patients were analysed. HCD use was associated with a significantly shorter LOS (average treatment effect of the treated population -1.87 days; 95% CI -3.04 to -0.695; P = .002), lower odds of ICU admission (odds ratio [OR] 0.29; 95% CI 0.16-0.53; P < .001), and lower in-hospital complication rates (OR 0.38; 95% CI 0.26-0.55; P < .001). Rates of pneumonia (5.2% vs 13.4%; P = .001), atrial fibrillation (2.2% vs 9.0%; P < .001), and retained pleural effusion (0.8% vs 3.6%; P = .015) were significantly lower in the HCD group. There were no significant differences in drain duration, readmission, or mortality. In the anatomical resection subgroup, HCDs were similarly associated with reduced LOS and complications. Hydrogel-coated drains are associated with fewer postoperative complications and shorter hospital stay compared to conventional drains, particularly in anatomical lung resections. These findings support further prospective evaluation to define the role of HCDs in routine thoracic surgical practice.