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<p><b>BACKGROUND</b>CKLF-like MARVEL transmembrane domain-containing 7 (CMTM7) located at 3p22.3, is a frequent deletion site and a tumor suppressor gene (TSG) locus in many cancer, which suggests CMTM7 may be a potential TSG. The aim of this study was to investigate the correlations of CMTM7 expression and survival rate in patients with non-smallcell lung cancer (NSCLC).</p><p><b>METHODS</b>Surgical specimens of 180 cases with pathologically confirmed NSCLC were grouped into 18 tissue microarray slides. CMTM7 expression in these specimens were detected by immunohistochemistry staining and representative cases were confirmed by Western blotting. Univariate and multivariate analyses were performed to identify the association of CMTM7 expression with pathological features and survival of patients with NSCLC.</p><p><b>RESULTS</b>A total of 78.9% of the 180 patients had variations of CMTM7 protein expression, either up-regulated or down-regulated. Univariate analysis showed that the patients' survival rate after surgery was highly correlated with CMTM7 expression (P = 0.0091). In addition, prognostic factors were examined by multivariate Cox regression analysis, and results suggested that CMTM7 expression was a unique prognostic factor in NSCLC survival.</p><p><b>CONCLUSIONS</b>The CMTM7 expression may be related to survival of patients with NSCLC and a unique prognostic factor. CMTM7 may play an important role in NSCLC development.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , Chemistry , Mortality , Pathology , Chemokines , Genetics , Physiology , Lung Neoplasms , Chemistry , Mortality , Pathology , MARVEL Domain-Containing Proteins , Genetics , Physiology , Prognosis , Proportional Hazards Models , Tissue Array Analysis , Tumor Suppressor Proteins , Genetics , PhysiologyABSTRACT
<p><b>BACKGROUND</b>Completely video-assisted thoracoscopic lobectomy is a reasonable treatment for early-stage non-small-cell lung cancer (NSCLC). At present, the indication for this procedure is stage Ia and Ib peripheral lung cancer (≤ 5 cm); however, for larger tumors, it remains controversial whether this surgical technique is comparable to open lobectomy. This study aimed to evaluate the safety, completeness, and efficacy of thoracoscopic lobectomy, and to compare this technique with open lobectomy for the treatment of non-small-cell lung cancer when the tumor's diameter was greater than 5 cm.</p><p><b>METHODS</b>From May 2001 to April 2011, 802 patients underwent a lobectomy for treatment of non-small-cell lung cancer at our center. In 133 patients, the tumor was > 5 cm. There were 98 men and 35 women, median age 63 years (range: 29 - 81 years). We divided the patients into two groups, group V (completely video-assisted thoracoscopic surgery), and group T (open lobectomy), and evaluated the two groups for age, gender, tumor size, pathological type, location, duration of surgery, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence.</p><p><b>RESULTS</b>There were 46 cases in group V and 87 cases in group T. Age, gender, tumor size, location, pathological type and stage were similar between the two groups. Group V had shorter operative duration ((186.5 ± 62.8) minutes vs. (256.7 ± 67.5) minutes, P < 0.001) and reduced bleeding ((218.5 ± 174.6) ml vs. (556.9 ± 187.2) ml, P < 0.001). There were no significant differences between the two groups in complications, lymph node dissection, time of drainage and hospitalization. The recurrence between the two groups was equivalent (2.4% vs. 3.8%, P = 0.670). The overall survival at 1, 2 and 3 years was 95.1%, 81.6% and 69.6% for group V and 88.3%, 78.8% and 64.0% for group T. Kaplan-Meier survival curves showed that there was no significant differences between the two groups (P = 0.129).</p><p><b>CONCLUSIONS</b>Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety, completeness, and efficacy, but had a shorter operative duration, and reduced bleeding. This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size > 5 cm.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , General Surgery , Kaplan-Meier Estimate , Pneumonectomy , Methods , Retrospective Studies , Thoracic Surgery, Video-Assisted , Methods , Treatment OutcomeABSTRACT
Objective To analyse the difference between stage Ⅰ pure bronchioloalveolar carcinoma (BAC) and stage Ⅰ adenocarcinoma of the lung among operative cases.Methods We use the Lobectomy Cases Registration and Statistics System database (2006-2011) to compare the epidemiology,clinical presentation,image characteristics,surgical outcomes,recurrence and overall survival between BAC and adenocarcinoma groups.All the patients received lobectomy procedure in the department of thoracic surgery of Peking University People' s Hospital.Results Excluding those cases with both BAC and adenocarcinoma aspects,337 patients were enrolled.Thirty-nine patients were stage Ⅰ pure BAC and 298 patients were stage Ⅰadenocarcinoma.BAC has its proper clinical spectrum,occurring more frequently in women (69.2％ vs.52.0％,P =0.042)and in younger patients (57.4 vs.61.8,P =0.014).BAC also seems to be less dependent on tobacco exposure (12.8％ vs.29.9％,P =0.026).The percentage of ground-glass opacity (GGO) in CT scan of BAC patients was much more than that registered in adenocarcinoma patients (35.9％ vs.9.7％,P ＜0.001).And the tumor size of BAC group was smaller than that of the adenocarcinoma group (1.4 cm vs.2.3 cm,P ＜0.001).The operation method,time,blood loss and complications were similar between the two groups.Kaplan-Meier survival curves showed that both 3-year disease-free survival (DFS) and overall survival (OS) were significantly higher in patients affected by BAC (100％ vs.76.1％,P =0.030 and 100％ vs.86.1％,P =0.041).Conclusion BAC presents specificity in its epidemical,clinical,radiological and evolutionary aspects.Stage Ⅰ pure BAC patients have better prognosis following video-assisted thoracoscopic lobectomy and system lymph node dissection than the similar stage adenocarcinoma patients.
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Objective To evaluate the long term effect of video-assisted thoracoscopic thymectomy for myasth,enia gravis and the influence of concomitant thymoma.Methods 47 cases of myasthenia gravis were retrospectively reviewed who had received video-assisted thoracoscopic thymectomy from Apr.2001 through Oct.2009.The patients were separated to two groups with or without thymoma.Influence of oncologic factors was carefully studied.Results There were 20 males and 27 females with a mean age of 36.6 yrs.According to the typing system of the Myasthenia Gravis Foundation of America ( MGFA),the patients belonged to type Ⅰ 18 cases,type Ⅱ a 14 cases,type Ⅱ b 14 cases,and Ⅲa 1 case.22 patients were in the group with thymoma,and the other 25 in the group without thymoma.Until the deadline of follow-up time of Jun.2011,only two cases in non-thymomatous group were lost.Follow-up time was 20 to 122 months,mean 57 months.The complete stable remission rate(CSR),pharmacologic remission(PR),minimal manifestations(MM),worse(W),exacerbation(E) and died of myasthenia gravis(D) in non-thymomatous group were 78.3％,13.0％,4.3％,0,0 and 4.3％.In thymomatous group the values were 50.0％,22.7％,13.6％,4.5％,9.1％ and 0.Conclusion Video-assisted thoarcoscopic thymectomy has a satisfactory long term effect for myasthenia gravis.Thymomatous group has no different in overall effectiveness with that of non-thymomatous group although a probably lower complete stable remission rate is prompted.
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Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010 ,29 patients ( 23 men , 6 women , median age 62.2 years , range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea, 1 at right main bronchus, 9 at right upper lobe, 1 at right median bronchus, 1 at right middle lobe, 4 at right lower lobe, 1 at left main bronchus, 9 at left upper lobe.There were 21 preliminary diagnostic cases and 8 postoperative surveillance cases. All procedure was performed under combination of local anaesthesia and general anaesthesia. All patients underwent white light bronchoscopy followed by AFB procedure.All of the suspicious abnormal sites were recorded and biopsied for pathological examination. Results All procedures were safely performed without death or serious complications. 100 specimens were obtained for pathologic examination. Malignant lesion was diagnosed in 39 and non-malignancy in61. All malignant sites were detected by AFB, however WLB missed 12 sites.The sensitivity of AFB and WLB for malignancy were 100% and 69.2%, respectively. In 21 preliminary diagnostic cases,AFB detected all malignancy sites, but WLB missed 23 sites, in which 9 were malignant sites. In 8 rechecked patients, AFB detected all malignancy sites, but WLB missed 7 sites, in which 3 were malignant sites. Conclusion Autofluorescence bronchoscopy could be more accurate in judging the extent of the tumor invasion, more sensitive in finding multiple lesions in airway, more sensitive in detecting early cancer recurrence in postoperative surveillance patients.
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Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective, a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan ( ≥ 1.0cm). Results Of the 52 patients, 41 patients were found with N2 or N3 disease on EBUS-TBNA. 11 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection, 9 patients were confirmed N0 by pathology, whereas 2 patients had metastatic lymph node. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBUS-TBNA for the mediastinal staging of lung cancer were 95.3%, 100%, 96.2%, 100%, and 81.8%, respectively. The procedure was uneventful, and there were no postoperative complications. Conclusion EBUS-TBNA is an effective and safe technique for mediastinal staging in lung cancer patients.
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<p><b>BACKGROUND</b>Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities.</p><p><b>METHODS</b>We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People's Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out.</p><p><b>RESULTS</b>Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed.</p><p><b>CONCLUSION</b>Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biopsy, Fine-Needle , Methods , Mediastinal Neoplasms , Diagnosis , Diagnostic Imaging , Mediastinum , Diagnostic Imaging , Pathology , Retrospective Studies , UltrasonographyABSTRACT
ObjectiveTo evaluate the feasibility of the completely thoracoscopic lobectomy for clinical N0 and postoperatively pathological N2 non-small-cell lung cancer(NSCLC).MethodsFrom Sep.2006 to Jan.2010, 216 patients with NSCLC received completely thoracoscopic lobectomy in our center.Two hundred and six patients were clinical N0 preoperatively(103 males and 103 females, median age of 62.3 years, rang 29 to 85 years).They were divided into two groups based on postoperatively pathological staging, pN0 group and pN2 group.Some perioperative factors including age, gender,tumor size,tumor location,pathological type, pathological differentiation,rate of conversion to thoractomy,operation time,blood loss,lymph node dissection, time of drainge, hospitalization and complications were studied and compared between two groups.Results There were 203 cases of lobectomy, 2 cases of composite lobectomy and 1 case of pneumonectomy.All procedures were carried out safely without serious complication except for one operative death result from respiratory failure.There were 168 cases in pN0 group and 38 cases in pN2 group.Age and gender were similar between two groups.The tumor size in pN0 group was smaller than that in pN2 group [ (2.6 ± 1.6) cm vs (3.7 ± 1.9) cm, P = 0.001 ].The tumors in pN0 group were lesser appearance in the bilateral lower lobes (31.0％ vs 50.0％, P = 0.026).There was a approximate proportion of adenocarcinoma in two groups (82.7％ vs 73.7％, P = 0.181), but the proportion of poorly differentiated carcinoma in pN0 group was significantly lower than that in pN2 group(19.0％ vs 42.1％, P = 0.002).There were no differences in the rate of conversion to thoractomy(7.1％ vs 7.9％, P = 1.000), operation time[ (196.1 ± 53.7) min vs (208.6 ± 56.8) min, P = 0.202 ], blood loss[ (253.2 ±247.9) ml vs(279.0±183.3) ml, P=0.475], time of drainage[ (7.7 ±3.2) days vs (9.7 ±6.3) days,P=0.066], hospitalization[ (10.6 ±4.6) days vs (13.0 ±7.6) days, P =0.063]and complications(12.5％ vs 21.1％,P =0.171).The stations of mediastinal lymph node dissection were equivalent in two groups(3.1 ± 1.2 vs 3.3 ± 1.1, P =0.237) , but there were fewer numbers of mediastinal lymph node dissection in pN0 group (9.9 ± 6.8 vs 12.7 ± 8.4, P =0.038).ConclusionCompletely thoracoscopic lobectomy is a feasible surgical therapy for cN0-pN2 non-small-cell lung cancer without loss of curability.
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Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of mediastinal lesions around the trachea.MethodsThe study was retrospective, between September 2009 to July 2010, 34 consecutive patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin underwent EBUS-TBNA.Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months clinical and radiologic follow-up.ResultsOf the 34 patients, EBUS-TBNA achieved definitive diagnosis in 28 patients (82.4％), 10 were diagnosed as malignancies, 18 were diagnosed as benign.The sensitivity, specificity,and accuracy of EBUS-TBNA in distinguishing benign from malignant mediastinal lesions were 90.9％, 100％, and 97.1％,respectively.EBUS was well tolerated by all of the patients with no complications.ConclusionEBUS-TBNA of mediastinal lesions around the trachea is a minimally invasive safe diagnostic technique with high yield.
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<p><b>BACKGROUND AND OBJECTIVE</b>The sensitivity and accuracy of white light bronchoscopy (WLB) in airway examination are low. Autofluorescence bronchoscope (AFB) can determine early lesions in bronchial mucosa more sensitively, but it has seldom performed in China. To assess the clinical value of the AFB in airway examination, we compared the sensitivity and specificity of the AFB and WLB in detecting cancer of the airway mucosa.</p><p><b>METHODS</b>Between September 2009 and May 2010, bronchoscope examinations using both the AFB and WLB were performed on 136 patients, 95 men and 41 women with a median age of 61.5 years (ranged from 25 to 84 years). There were 46 lesions located in the central airway, 84 in the peripheral lung parenchyma, and 6 in the mediastinal region. All patients received local and general anesthesia and were subsequently examined with the WLB and AFB in tandem. All procedures were completed safely. Abnormal visual findings were recorded, and biopsies of the affected regions were collected for pathologic examination.</p><p><b>RESULTS</b>Of 241 regions sampled for biopsy, 76 sites contained malignant lesions, whereas 165 sites contained benign lesions. The AFB detected 72 of the 76 malignant lesions, but the WLB detected only 50. The sensitivities of the AFB and WLB were 94.7% and 65.8%, respectively, and the specificities were 57.0% and 83.6%, respectively. The negative predictive values of the AFB and WLB were 95.9% and 84.1%, respectively.</p><p><b>CONCLUSIONS</b>The AFB is more sensitive than the WLB in detecting cancerous lesions in the mucosa, and is an effective airway examination.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma , Diagnosis , Pathology , Biopsy , Bronchoscopy , Methods , Carcinoma, Squamous Cell , Diagnosis , Granuloma , Diagnosis , Inflammation , Diagnosis , Lung Diseases , Diagnosis , Lung Neoplasms , Diagnosis , Sensitivity and Specificity , Small Cell Lung Carcinoma , DiagnosisABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Solitary pulmonary nodules (SPN) is a knotty problem in clinical work. The clinical manifestation and pathological features of SPN in sizes may be obviously different. The aim of this study is to analyze the relationship between the diameters and clinicopathologic characteristics of SPN.</p><p><b>METHODS</b>390 patients (212 male, 178 female, ranging from 17 years to 86 years, median age 57.1 years) with SPN who were postoperatively diagnosed by pathology between Jan. 2000 and Jun. 2009 are enrolled to this study. In these cases, the number of SPN diameters which are smaller than 0.5 cm (including 0.5 cm) (group A) is 16, between 0.5 cm and 1 cm (including 1 cm, not including 0.5 cm) (group B) is 58, between 1 cm and 2 cm (group C) is 163, and between 2 cm and 3 cm (group D) is 153. The clinical manifestation, and postoperative pathological characters are analyzed in various diameter ranges.</p><p><b>RESULTS</b>All procedures were carried out securely, including tumor enucleation (n = 20), wedge resection (n = 153), lobectomy (n = 217). There are 130 benign cases (33.3%) and 260 malignant cases (66.7%). 58.5% SPN are detected incidently with no symptoms. There is an increasing incidence of clinical symptoms as the increasing diameter of SPN. All the cases are divided into 4 groups, the prevalence of malignant are separated 43.7% (group A), 50.0% (group B), 63.2% (group C), 79.1% (group D). The diameter of SPN is positively correlated with incidence of malignancy (chi2 = 22.535, P < 0.001). Single factor analysis and Logistic regression analysis show the diameter of SPN is an independent risk factor of malignant pathology (OR = 1.922, P < 0.001). Fourteen patients in all of the SPN were followed up by 2 years or more before operation, and 10 of them turn out to be malignant at last. In the 14 patients, 7 cases were found not enlarged by CT scan, and 3 of them (42.9%) were malignant.</p><p><b>CONCLUSION</b>The diameter of SPN is highly associated with clinical symptoms, and is a significant risk factor to predict pathology. Early diagnosis and treatment is so important for patients with SPN.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Lung Neoplasms , Pathology , General Surgery , Solitary Pulmonary Nodule , Pathology , General SurgeryABSTRACT
Objective To evaluate the analgesic efficacy of thoracic paravertebral block (PVB) in patients after lobectomy performed via video-assisted thoracoscope (VAT) .Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes aged 20-76 yr weighing 45-90 kg undergoing elective lobectomy via VAT were randomly divided into 2 groups (n = 25 each): patient-controlled intravenous analgesia (PCIA) group and thoracic PVB group. PVB was performed according to the method described by Jamieson et al and Richardson et al. Paravertebral catheter was placed at T7-8 after induction of anesthesia and tracheal intubation. A loading dose of 0.5% ropivacaine 20 ml was administered via PVB catheter at 30 min before the end of operation. PVB was then controlled by the patients with 0.2% ropivacaine (bolus dose 8.0 ml, lockout interval 30 min). In PCIA group a loading dose of sufentanil 0.1 μg/kg was given iv at 30 mln before the end of operation. Sufentanil 1.0 μg/ml was used. PCIA included a bolus of 2 ml with a 15 min lockout interval and background infusion 2 ml/h. Numeric rating scale (NRS) (0=no pain, 10 = most severe pain) was used to assess the intensity of pain. NRS score, MAP, HR and SpO2 were recorded before operation (T0 ,baseline), 30 min after withdrawal of chest tube (Ti) and at 24, 48 and 72 h after operation (T2, T3, T4). Forced vital capacity (FVC) and forced expiratory volume first second (FEV1.0) were measured and FVC/FEV1.0 ratio was calculated after chest tube was withdrawn. Blood cortisone and glucose concentrations were determined at To, T1 and T4. Requirement for rescue analgesics and side effects were recorded. Results There was no significant difference in MAP, HR, SpO2 and NRS at rest between the 2 groups.NRS at coughing and blood cortisone and glucose concentrations were significantly lower and the postoperative FEV1.0 was significantly higher in PVB group than in PCIA group. The requirement for rescue analgesics and side effects were comparable between the 2 groups. Conclusion Thoracic PVB can provide better postoperative analgesia with little side effects.
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Objective To evaluate the effectiveness of midazolam and morphine combined with TCI of propofol for endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA ). Methods Forty ASA Ⅰ or Ⅱ patients undergoing elective EBUS-TBNA were randomly divided into 2 groups according to the plasma concentration (Cp) of TCI of propofol (n=20 each): group Ⅰ Cp = 3 μg/ml (group P1) and group Ⅱ Cp = 4 μg/ml (group P2 ). Midazolam 0.03 mg/kg and morphine 0.05 mg/kg were administered iv followed by topical anesthesia of laryngopharynx with 4% hdocaine. TCI of propofol was started at 5 min before surgery. The patients kept spontaneous breathing during operation. MAP, HR and SpO2 were continuously monitored and recorded before anesthesia (baseline) and at 30 min after beginning of surgery and emergence from anesthesia. Arterial blood gas analysis was performed at 30 min after beginning of surgery and PETCO2 was measured at the end of surgery. The amount of 4% lidocaine used for topical anesthesia, the adverse reactions and the level of patient's satisfaction were recorded. Results PaO2 and pH value were significantly lower while PaCO2 and PET CO2 higher in group P2 than in group P1. There was no significant difference in the emergence time, the amount of 4% lidocaine used,the adverse reactions and the level of patient's satisfaction between the 2 groups. Conclusion TCI of propofol at Cp of 3 μg/ml can provide satisfactory anesthesia for EBUS-TBNA with less respiratory depression and more rapid emergence than that at Cp of 4 μg/ml.
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Objective To optimize operative techniques of completely video-assisted thoracoscopic lobectomy by reviewing the experience of Peking University People's Hospital. Methods From September 2006 to August 2010, 408 patients (214 males,194 females) with median age of 58.6 years (range from 15 to 86 years) underwent completely thoracoscopic lobectomy. All procedures were conducted under general anesthesia with double lumen intubation. The thoracoscope was introduced through 7th or 8th intercostals space on the mid-axillaries line. The 4 cm long utility incision was made on the 4th or 5th intercostals space anterior axillary's line without rib-spreading. A third retraction incision located on the 7th or 8th intercostals space sub-scapular line. The surgeon stands on the ventral side of patient using an electrocautery hook and a suction device through the utility incision. Anatomic lobectomy was performed with systemic mediastinal lymph node dissection for lung cancer patients. Results All procedures were carried out smoothly with no case of serious complication. There was 1 case death because of respiratory failure of pulmonary fungal infection during the operative period. The average surgical duration was 195 minutes, and average blood loss was 249 ml with no blood transfusion required. There were 35 cases (8.6%) of conversion to open thoracotomy, including interference by lymph nodes, bleeding, inflammatory adhesion of Artery and large size tumors.The results of pathology show 322 cases of malignant disease and 86 cases of benign disease. Conclusion To grasp the core technique of completely thoracoscopic lobotomy may make the procedure undergone smoothly, and may shorten the learning curve.
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Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for CT-positive mediastinal lymph nodes. Methods From September 2009 to December 2009, 28 patients with confirmed or suspected non-small-cell lung cancer with CT scan demonstrating enlarged ( ≥ 1 cm) mediastinal lymph nodes underwent EBUS-TBNA. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were evaluated. Results 28 patients with 40 lymph nodes were studied. 27 patients had been performed successfully with enough specimens. No complications happened in the group. Mediastinal metastases were confirmed by EBUS-TBNA in 20 patients. 8 patients with benign mediastinal nodes as detected by EBUS-TBNA underwent surgery and mediastinal lymph node dissection, which confirmed N2 disease in 2 patients. Overall diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA in the detection of mediastinal metastasis were 92.9%, 90.9%,100%, 100%, 75% respectively. Conclusion EBUS-TBNA is a safe and effective technique for CT-positive mediastinal lymph nodes on CT scan.
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Objective To discuss the safety, completeness and efficiency of the completely thoracoscopic lobectomy for non-small-cell lung cancer(NSCLC) which the tumor's diameter was larger than 5 centimeters. Methods From September 2006 to December 2009, 214 patients of NSCLC received completely thoracoscopic lobectomy in our center. There were 108 males and 106 females with median age of 62.5 years( range from 29 to 85 years). Patients were divided into two groups, group A ( diameter≥5 cm) and group B ( diameter ＜5 cm). We compared all the factors of age, gender, pathological type, location,rate of conversion to thorsctomy, operation time, blood loss, lymph node dissection, pathological stage, time of drainge, hospitalization, complications, overall survival and recurrence between two groups. Results Surgical procedures included lobectomy in 211 cases, composite lobectomy in 2 and pneumectomy in 1. All procedures were carried out safely without serious complication except one operative death result from respiratory failure. There were 30 cases in group A and 184 in group B. Age and gender were similar between two groups. The proportion of squamous cell carcinoma in group A was higher than it in group B (46.7% vs. 13.6% ,P ＜0.001 ). There were no differences in safety factors such as rate of conversion to thorsctomy( 16.67% vs. 7.61%,P =0.204), operation time[(214.0 ±58.1)min vs. (198.6 ±55.1)min, P=0.160], blood loss [(283.3 ±179.7)ml vs. (248.5 ±25.7)ml, P=0.559] and complications (13.33% vs. 14.67%,P=1.000). The completeness factors of lymph node dissection stages (5.0 ± 2.4 vs. 5.0 ± 1.7, P = 0.990 ) and numbers( 19.1 ± 10.1 vs.15.8 ± 8.8, P = 0.065 ) were equivalent between two groups. The estimated overall survival at 1 year was 81.25% for group A and 92.63% for group B ( P = 0.226). The recurrence of two groups was 3.45% vs. 2.23% (P = 0.532 ), respectively.Conclusion Completely thoracoscopic lobectomy can be done safely,completely and efficiently for non-small-cell lung cancer which the tumor's diameter was larger than 5 centimeters.
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<p><b>OBJECTIVE</b>To review the technology of completely thoracoscopic lobectomy procedures.</p><p><b>METHODS</b>From September 2006 to July 2007, 40 patients (23 male and 17 female) underwent completely thoracoscopic lobectomy. The median age was 59.5-years-old, with a range from 24 to 79-years-old. The lobectomy was completed through 3 incision in the 5th, 8th and 7th intercostal space. The procedures were similar with conventional open lobectomy.</p><p><b>RESULTS</b>All procedure were carried out safely, including lung cancer (n = 34), lymphoma(n = 1), pulmonary cyst (n = 1), middle lobe syndrome (n = 1) , bronchiectasis (n = 2) and renal carcinoma metastasis to lung (n = 1). There were no operative mortality or serious complications. There was one patient opposed to open thoracotomy because of the mediastinal lymph nodes metastasis. The average surgical duration was 206 min (range from 60 to 300 min). The average blood loss was 221 ml (range from 100 to 400 ml) with no blood transfusion required. The average length of stay was 8.9 d. No recurrence and metastasis was observed in a follow-up range from 1 to 10 months except one patient with adenocarcinoma occurred metastasis of tumor 3 months postoperation.</p><p><b>CONCLUSION</b>The completely thoracoscopic lobectomy is a safe and feasible surgical procedure compared with conventional open lobectomy for selected patients.</p>