Target trial emulation (TTE) is a causal inference framework for real-world research. It starts from a clearly defined causal question and emulates the rigorous design and procedures of randomized controlled trials (RCTs) to systematically reduce bias and enhance the validity of real-world evidence. According to research objectives, target trials can be classified as emulation or duplication. The emulation uses real-world data (RWD) and idealized RCTs designs to address causal questions lacking randomized evidence, whereas the duplication compares results between TTE and existing RCTs to assess concordance in regulatory conclusions, effect direction, and effect magnitude, thereby verifying data quality and methodological robustness. Increasing attention from regulatory agencies has underscored the potential of TTE in clinical decision-making, drug re-evaluation, and health policy assessment. However, despite the growing number of studies, many TTE applications show methodological heterogeneity, inconsistent design and analysis, and limited reporting transparency, which constrain their evidentiary value. This paper outlines the theoretical foundation and design principles of TTE, summarizes key analytical strategies and reporting standards, and presents representative applications to provide researchers with a practical framework for standardized and methodologically sound implementation of TTE in real-world studies.
ObjectiveTo investigate the application effect of dual-instrument nurse teamwork in concurrent thoracoscopic and laparoscopic radical resection for esophageal cancer using an inflatable mediastinoscopy. MethodsA retrospective analysis was conducted on surgical data of patients who underwent concurrent thoracoscopic and laparoscopic radical resection for esophageal cancer using an inflatable mediastinoscopy between 2021 and 2024 at five domestic hospitals by the same surgical team. Patients were divided into an observation group (two instrument nurses working simultaneously) and a control group (one instrument nurse working independently) based on the number of instrument nurses involved. After propensity score matching (1:1), the baseline characteristics, perioperative parameters, complication rates, postoperative pulmonary function status, immune stress response indicators, and surgical coordination quality were compared between groups. ResultsA total of 480 patients were enrolled, including 287 males and 193 females with a mean age of (53.90±7.81) years. After propensity score matching, 224 patients were analyzed per group. The operation time in the observation group was significantly shorter than that in the control group [(84.32±19.77) min vs. (95.23±29.54) min, P<0.001]. Compared with the control group, the observation group demonstrated reduced intraoperative blood loss and postoperative drainage volume, earlier first flatus time, oral intake time, and initial ambulation time, lower pain scores at 24 hours postoperatively, and decreased overall complication rates (all P<0.05). However, no significant difference was observed in the number of dissected lymph nodes between groups (P>0.05). Postoperative pulmonary function indicators were significantly higher in the observation group (P<0.05). Immune and stress response markers were markedly lower in the observation group (P<0.05), while the overall surgical coordination quality score was significantly higher (P<0.001). ConclusionDual-instrument nurse teamwork during concurrent thoracoscopic and laparoscopic radical resection for esophageal cancer using an inflatable mediastinoscopy optimizes surgical workflow efficiency and quality, thereby promoting postoperative patient recovery.
