Minimally invasive surgery for centrally located lung cancers / 中华外科杂志

Minimally invasive surgery helps enhance postoperative recovery and improve quality of life of the patients by minimizing surgical trauma and decreasing incisional pain. Minimally invasive pulmonary resection, including both video-assisted thoracoscopic surgery and robotic surgery, is mainly used for surgical management of peripheral early stage lung cancers. Because of tumor location, lymph node involvement, and treatment modalities, surgery for central lung cancers is often technically demanding. Open thoracotomy is still the dominant approach for these tumors, especially when complex procedures such as sleeve lobectomy or pneumonectomy are needed. With the advent of surgical techniques, minimally invasive techniques have started to be tried in treatment of central lung cancers. Initial results have proven their feasibility and safety in sleeve lobectomy and pneumonectomy, showing a great potential of minimally invasive surgery in the future. Further study is necessary to prove its functionally superiority and oncological equivalence to open surgery, so that more lung cancer patients could benefit for minimally invasive surgery.

Postoperative nutrition in patients with esophageal cancer: a prospective randomized controlled study / 中华胸心血管外科杂志

Objective To observe the effects of total enteral nutrition ( TEN) and early combined parenteral nutrition ( PEN+TEN) in patients with esophageal cancer after operation .Methods The prospective,random, controlled clinical trial was adopted.One hundred patients receiving esophageal cancer operation were randomly assigned to the TEN group (50 cases) and the PEN+TEN group(50 cases).The differences in nutritional status, inflammatory response, immune status and postop-erative complications were compared in the two groups before and after operation.Results The levels of total serum protein, albumin or retinol binding protein were higher in the PEN group than the TEN group at the 10th day after operation, respective-ly[(60.1 ±6.2)g/L vs(55.3 ±9.3)g/L,(36.4 ±4.2)g/L vs(34.6 ±1.6)g/L,(43.3 ±5.9)g/L vs(34.9 ±3.3)g/L, P<0.05] .The levels of ESR or CRP were higher in PEN +TEN group than the TEN group at the 10th day after operation, re-spectively [(54.9 ±25.8)mm/h vs(31.8 ±14.2)mm/h,(30.9 ±13.2)g/L vs(15.8 ±6.1)g/L, P<0.01] .The levels of CD3+, CD4 +, or CD8 +were higher at the 10 th day after operation than at the day before surgery in TEN group [(59.6 ±9.8)％vs(68.3 ±4.4)％,(41.7 ±7.8)％vs(46.5 ±5.5)％,(23.2 ±5.5)％vs(20.0 ±2.7)％, P<0.05], but not in PEN+TEN group.The levels of IgA or IgG were significant higher in the TEN group than the PEN +TEN group at the 10th day after operation[(1.9 ±0.5)g/L vs(1.6 ±0.3)g/L,(11.9 ±3.3)g/L vs(9.4 ±2.2)g/L, P<0.01].Con-clusion The inflammatory reaction and immune function in TEN group are better than those in PEN +TEN group.Although the nutritional status is worse in the TEN group than that in the PEN group , but the rate of postoperative complications has not increased.

Correlation between Serum Cytokeratin 19 Fragment and the Clinicopathological Features and Prognosis of Thymic Epithelial Tumors / 中国肺癌杂志

BACKGROUND@#So far there's no tumor maker applied in diagnosis and treatment of thymic epithelial tumors. This study is to assess the correlation between serum cytokine 19 fragment (Cyfra 21-1) and clinicopathological features and prognosis of thymic epithelial tumors (TETs).@*METHODS@#The clinical data of 159 patients with TETs in Shanghai Chest Hospital was retrospectively analysed. Patients were divided into groups according to different tumor stages and histotypes. Serum Cyfra 21-1 was thus compared. In addition, the possible relationship between perioperative serum Cyfra 21-1 level and the recurrent status was carrid out.@*RESULTS@#Preoperative Cyfra 21-1 serum concentrations in patiants with advanced stage (T4) and thymic carcinomas were significantly higher than that in others (P<0.001, P<0.001, respectively). When the preoperative serum level exceeds the out-off of 1.66 ng/mL, it possibly indicates the recurrence during follow up. Furthermore, the sensitivity, specificity, and positive as well as negative predictive value (PPV and NPV) of postoperative Cyfra 21-1 to predict tumor recurrence were evaluated. At a cut-off of Cyfra 21-1 of 2.66 ng/mL, the sensitivity was 0.7, the specificity was 0.925, the PPV was 0.5 and the NPV was 0.966.@*CONCLUSIONS@#The elevated level of preoperative serum Cyfra 21-1 indicates an advanced stage of tumor or a more malignant histotype (thymic carcinoma). It also probably suggests a higher risk of tumor recurrence. During the oncological follow up, in addition to regular imaging examinations, the blood test of serum Cyfra 21-1 is also suggested to improve the diagnosis of tumor recurrence in order to improve the prognosis.

Associated factors of postoperative relapse and metastasis in pT1bN0M0-pT4aN0M0 thoracic esophageal squamous cell carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the associated high risk factors of postoperative relapse and metastasis for patients with confined tumors (grade pT1b-4a) without lymph-node metastases (pN0) in thoracic esophageal squamous cell carcinoma (ESCC).</p><p><b>METHODS</b>Clinicopathological and follow up data of ESCC patients undergoing radical surgical resection as primary treatment in the Department of Thoracic Surgery, Shanghai Chest Hospital between January 2004 and December 2012 from Hospital Database were retrospectively collected. The inclusion criteria were as follows: (1) the first development of ESCC confirmed by histopathology without lymphatic and distant metastasis; (2) pathological stage of pT1bN0M0 to pT4aN0M0 according to the Union for International Cancer Control (UICC) in 2009; (3) curative trans-thoracic esophagectomy with R0 (tumor-free surgical margin) resection, using the Ivor-Lewis or McKeown procedure; two-field lymphadenectomy or three-field lymph node dissection based on the positive results of preoperative cervical ultrasonography examination or CT scan; (4) without adjuvant chemotherapy and/or radiotherapy before and after operation; (5) complete follow-up data. Logistic regression analysis was employed to identify the clinicopathological factors affecting the postoperative relapse and metastasis.</p><p><b>RESULTS</b>A total of 112 patients were eligible, including 94 male cases and 18 female cases; age of (58.6±7.7) years; squamous carcinoma of upper thorax in 25 cases, of middle thorax in 67 cases and of lower thorax segment in 20 cases; 12 cases of high-differentiated ESCC, 49 cases of moderate-differentiated ESCC, poorly-differentiated ESCC in 48 cases; 4 cases of I(a stage, 9 cases of I(b, 24 cases of II(a, 62 cases of II(b, 13 cases of III(a; the tumor length >4 cm in 43 cases, ≤4 cm in 69 cases. Forty-three (38.4%) patients presented relapse or metastasis during the follow-up, including 24 (21.4%) of loco-regional relapse, 13 (11.6%) of distant metastasis, and 6(5.4%) of both above. Multivariate regression analysis revealed that poorly-differentiated tumor (OR=1.899, 95%CI:1.233-2.925, P=0.004), upper-middle location (OR=2.351, 95%CI:1.188-4.653, P=0.014), and tumor length >4 cm (OR=2.381, 95%CI:1.009-5.618, P=0.048) were independent risk factors of overall postoperative relapse and metastasis for thoracic ESCC with stage pT1b N0M0-T4aN0M0. Further stratified analysis identified that only poorly-differentiated tumor (OR=1.730, 95%CI:1.121-2.671, P=0.013) was an independent risk factor of loco-regional relapse, whereas pathological stage II(b-III(a (OR=3.372, 95%CI:1.206-9.428, P=0.021) was an independent risk factor of distant metastasis.</p><p><b>CONCLUSIONS</b>Poorly-differentiated tumor, tumor length >4 cm, and upper-middle location may be regarded as high risk factors for predicting overall relapse and metastasis of pN0 thoracic ESCC patients after esophagectomy. Moreover, poorly-differentiated tumor is the only independent risk factor of postoperative loco-regional relapse, meanwhile it should be noted that pathological stage II(b-III(a is closely related to postoperative distant metastasis.</p>

Clinical analysis of 41 cases with resected multiple primary lung cancers / 中国癌症杂志

Background and purpose:Multiple primary lung cancers (MPLC) is a rare entity, but recently there has been a gradual increase in the number of patients diagnosed with MPLC. The aim of this study is to investigate the diagnosis, treatment and prognosis of MPLC through analyzing the clinical data.Methods:Forty-one patients were diagnosed MPLC by Martini-Melamed criteria. Their clinicopathological data were retrospectively reviewed. Results:There were 3 patients with triple primary lung cancer and 38 patients with double primary lung cancer. There were 13 patients with synchronous MPLC, 26 patients with metachronous MPLC, 2 patients with synchronous and metachronous MPLC. Of 85 lesions, the surgical procedures were mainly lobectomy (78.8%, 67/85). Lesions (41.2%, 35/85) were frequently in right upper lobe. Pathological type was mainly adenocarcinoma (70.6%, 60/85),followed by squamous cell carcinoma (17.6%, 15/85). Of 60 adenocarcinoma specimens, the papillary predominant subtype was more common (50%, 30/60). Eighty percent (68/85) of the lesions were stage I. As to the initial cancer and repeated cancer, patients who shared the same pathological type (68.3%, 28/41) were more than the different (31.7%, 13/41), of which adenocarcinoma-adenocarcinoma was most common(82.1%, 23/28). Lesions located in contralateral lobes were in 37 patients (90.2%), and located in ipsilateral different lobes were in 4 patients (9.8%). The 2-year overall survival (OS) of them was 87.8%. Survival analysis showed that the prognosis of patients with same pathological type was better than patients with different pathological type (P=0.037), the prognosis of patients with no lymph node metastasis was better than patients with N1,N2 metastasis (P=0.02).Conclusion:Lesions in patients with multiple primary lung cancers are more frequently in the right upper lobes. The pathology type is mainly adenocarcinoma, of which the papillary predominant subtype was most common. Early diagnosis improves continuously, active treatment with operation can achieve better prognosis.

Surgical treatment for pleomorphic pulmonary carcinoma: a single-center analysis of 60 patients / 中华胸心血管外科杂志

Objective To investigated the clinicopathological findings and prognosis of 60 patients with pleomorphic carcinoma.Methods 60 cases of pleomorphic pulmonary carcinoma were collected and studied clinicopathologically between 1999 and 2011.All patients underwent pulmonary resections.Results There was no in-hospital death.1 had haemothorax that required reoperation,1 patient had a late cicatricial bronchial stenosis after sleeve lobectomy of the upper right lobe,and treated successfully by the resection of the right two lobes.The 3,5-year survival rates of all patients were 47.2％ and 25.6％ respectively.For N0 and N1-N2 patients,3-,5-year survival rates were 57.3％,32.5 ％ and 25.4％,17.1％,respectively.Overall survivals were of significant difference between radical resection and uncomplete resection.Multivariate Cox regression analyses of overall survival of all 60 patients indicated that radical resection (P =0.041) and nodal status (P =0.029) were significant independent prognostic factors.Conclusion Pleomorphic carcinoma is a rare type of lung cancer.Pleomorphic carcinoma of the lung was often found as a large mass peripherally located and was associated with poor prognosis.Radical resection and nodal status were significant independent prognostic factors.

The surgical treatment of malignant tracheal tumor / 中国医师进修杂志

Objective To summarize the clinical experience of surgical treatment of malignant tra-cheal tumor.Methods Two hundred and fifty-eight medical charts about surgical treatment of malignant tracheal tumor between July 1980 and July 2007 were retrospectively reviewed.The main histological type were adenoid cystic carcinoma (104/258) and squamous cell carcinoma (93/258).Operative methods in-cluded circumferential resection end to end anastomosis of trachea (n=157),carinal resection and re-construetion (n=51),sleeve pneumonectomy(n=22),windowing removal(n=23),tracheal allotrans-plantation(n=2),circumferential reflection and anastomosis of trachea with assistance of extracorporeal cir-culation (n=3).Results No patient died from operation in the 258 cases,and the overall 5-and 10-year survival rates were 64.O%(165/258)and 58.1%(150/258),respectively.The morbidity rate was 5.4%(14/258).Conclusiom Surgical excision is the most effective treatment of malimmnt tracheal tumor.Tracheal resection and carinal reflection are the main operative methods in the treatment of malignant tracheal tumor.Decreasing operative complications is the key of successfully surgical treatment.

Sleeve resection of bronchus and pulmonary artery for central type lung cancer / 中国癌症杂志

Background and purpose:In recent years,sleeve resection of bronchus and pulmonary artery has been more extensively applied in treatments of lung cancer patients with poor pulmonary functions.This kind of surgery meets the basic surgical principles of lung cancer being maximum both in resecting the carcinoma of the lungs and preserving pulmonary functions,has a good prospect.Therefore,we summarize our recent experience in treating central type lung cancer by this method and discuss its principles and methods in the application of the surgical operation.Methods:From Dec.1993 to Dec.2003,63 patients with central type lung cancer underwent sleeve lobectomy of bronchus and pulmonary artery,including sleeve resection of bronchus and pulmonary artery in 43 cases,wedge resection of bronchus and pulmonary artery in 3 cases,sleeve resection of bronchus and wedge resection of pulmonary artery in 17 cases.The surgical procedures of sleeve resection included sleeve resection of right upper lobe and pulmonary artery in 20 cases,sleeve resection of left upper lobe and pulmonary artery in 23 cases,and the length of pulmonary artery that had been respected is from 1.5cm to(4.5cm),the average length is 2.5cm.The surgical procedures of wedge resection included wedge resection of right upper lobe and pulmonary artery in 2 cases, wedge resection of left upper lobe and pulmonary artery in 1 case.The group of sleeve resection of bronchus with wedge resection of pulmonary artery included sleeve resection of right upper lobe and wedge resection of pulmonary artery in 5 cases,sleeve resection of left upper lobe and wedge resection of pulmonary artery in 12 cases.Results:No case of death and anastomotic leak occurred.Conclusions:Because sleeve resection of bronchus and pulmonary artery can not only effectively resect the tumor but also maximally preserve the pulmonary function at the same time,it enlarges the surgical indications of lung cancer,and is an effective and safe method for the treatment of lung cancer.