ABSTRACT
Background and purpose:Life expectancy has continuously improved in recently years with the development of medical level. In 2012, the amount of people who were above 60 years old has reached 810 million and account for 11% of worldwide population. The worldwide population shift towards older ages will inevitably lead to more elderly patients being diagnosed with non-small cell lung cancer (NSCLC). It still remains controversial whether sublobar resection is effective in such cases. In order to solve this question, we need to understand the clinical characteristics of these tumors. Methods:From 2006 to 2012, a total of 310 patients with NSCLC who were above 65 years old underwent surgical resection in Department of Thoracic Surgery, the First Afifliated Hospital of China Medical University and the Second Department of Thoracic Surgical Oncology, Jilin Province Tumor Hospital. The clinical data were retrospectively analyzed in sex, stage, histology, smoking status, smoking amount, drinking status, surgical approaches, multimodality therapy and overall survival. Survival was analyzed by Kaplan–Meier method and log-rank test. Results:There were 256 (82.6%) elderly patients who underwent standard lobectomies and 54 (17.4%) patients who underwent sublobar resections. The overall 5-year survival rate was 52.9%. Patients with different surgical approaches (lobectomy and sublobar resection) had nearly the same 5-year survival rates (60.5%vs 60.8%, P=0.381). The prognosis were signiifcantly inlfuenced by gender (P=0.024), stage of disease (P=0.028), smoking status (P=0.034) and smoking amount (P=0.028). The multivariate Cox proportional hazards analysis revealed that the smoking status was associated with the hazard ratio of 1.660 (1.058-2.606;P=0.028). Conclusion:In elderly NSCLC patients, sublobar resection is considered to be an appropriate treatment in comparison with lobectomy, as this procedure provides an equivalent long-term survival. The survival of elderly patients with lung cancer is closely related to the smoking status.
ABSTRACT
Background and purpose:Lung cancer is currently the greatest threat to human life and health of the malignant tumor, clinical examination revealed a solitary pulmonary nodules (SPN), including a signiifcant portion of early stage lung cancer. The research aimed to discuss the diagnosis value of CT guidance Hookwire positioning thoracoscopic surgery for solitary pulmonary nodule. Methods:From Jul. 2011 to Jun. 2013, 310 SPN patients in the Department of Thoracic Surgery of Fudan University Shanghai Cancer Center were collected. Hookwire positioning pins were retained guided by CT scan into the patients’ body. Video assisted thoracic surgery (VATS) pulmonary wedge resection was adopted. According to the result of intraoperative frozen pathology, further treatment method was decided. Positioning accuracy, complications, VATS lung wedge resection surgery successful rate, transfer rate in the chest and SPN pathological classiifcation and other indicators were calculated with statistical methods. Results:Hookwire positioning successful rate was 100%, meanwhile, 2 patients with hemoptysis received symptomatic treatment.Intraoperative Hookwire fell off in 12 patients (3.87%), VATS wedge resection surgery successful rate was 99%, transit thoracotomy was carried out in 3 patients. SPN postoperative histological pathology results:237 cases with primary lung cancer, 73 cases with benign lesions. Conclusion:The method of CT guided Hookwire thoracoscopic surgery after positioning in treatment of SPN has higher diagnostic accuracy rate, reliable curative effect, fewer complications and great value in clinical promotion.