Application value of lymph node-targeted chemotherapy in resection of the esophageal carcinoma: a prospective study / 中华消化外科杂志

Objective To investigate the application value of lymph node-targeted chemotherapy in resection of esophageal carcinoma.Methods The prospective study was conducted.The clinical data of 117 patients with middle and low esophageal carcinoma (without involving esophagogastric junction) who underwent left transthoracic esophagectomy and regional lymph node dissection in the West China Hospital of Sichuan University between January 2013 and December 2013 were collected.All patients were allocated into the 4 groups by semi-randomized control method:CPL group received intraoperatively carbon nanoparticles-paclitaxel for lymph node-targeted chemotherapy,CFL group received intraoperatively carbon nanoparticles-fluorouracil for lymph nodetargeted chemotherapy,FV group received preoperative fluorouracil intravenous chemotherapy,and control group underwent left transthoracic esophagectomy and regional lymph node dissection.CPL and CFL groups:suspensions of carbon nanoparticles and chemotherapy drugs were preoperatively prepared,and were intraoperatively injected under mucosa of lower edge of thoracic esophageal tumor using 0.1 mL syringes.FV group:fluorouracil with 100 mL of saline were mixed,and then were preoperatively injected by intravenous drip within 30 minutes.After cutting tissues of esophageal carcinoma,lymph nodes of left gastric arteria were removed,and drug level in lymph nodes was measured.At the beginning of esophagogastrostomy in the CPL,CFL and FV groups,3 mL peripheral venous blood were collected and measured for serum drug level.Control group:patients underwent left transthoractic esophagectomy and regional lymph node dissection (no blood sample and esophageal specimen).Observation indicators:(1) comparison of drug levels in lymph node and serum of patients with chemotherapy;(2) follow-up and survival:4-year cumulative survival rate in 4 groups.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to December 2017.Measurement data with normal distribution and homogeneity of variance were represented as (x)±s,and comparisons among groups were analyzed using the ANOVA.Measurement data with skewed distribution were described as M (P25,P75),and comparisons among groups and between groups were respectively analyzed using the Kruskal-Wallis rank test and Mann-Whitney U test or Wilcoxon signed rank test.Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Ordinal data were compared by the Kruskal-Wallis test.The survival curve was drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results One hundred and seventeen patients were screened for eligibility,including 90 males and 27 females,and age was 37-84 years old,with an average age of 62 years old.Of 117 patients,41,41,9 and 26 were respectively allocated into the CPL,CFL,FV and control groups.Eligible patients recovered and were discharged from hospital,without bone marrow depression,severe diarrhea,anastomotic leakage and severe pneumonia.(1) Comparison of drug levels in lymph node and serum of patients with chemotherapy:drug levels in the CPL,CFL and FV groups were respectively 2.16 μg/g (1.14 μg/g,4.39 μg/g),0.44 μg/g (0.11 μg/g,1.18 μg/g),0.11 μg/g (0,0.28 μg/g) in lymph nodes and 0 (0,0),0 (0,0.31 μg/mL),0 (0,0.30 μg/mL) in serum.Drug levels of lymph node in the CPL and CFL groups were higher than those of serum,with statistically significant differences (Z=-5.579,-3.069,P＜0.05).There was no statistically significant difference in drug levels of lymph node and serum of FV group (Z =-0.365,P＞0.05).There was a statistically significant difference in drug levels of lymph node among CPL,CFL and FV groups (H=33.458,P＜0.05),and in drug levels of serum among CPL,CFL and FV groups (H=10.356,P＜0.05).Further analysis showed that fluorouracil level of lymph node in the CFL group was higher than that in the FV group,with a statistically significant difference (Z =82.500,P＜ 0.05),and there was no statistically significant difference in fluorouracil level of serum between CFL group and FV group (Z =160.500,P＞0.05).Paclitaxel level of lymph node in the CPL group was higher than fluorouracil level of lymph node in the CFL group,with a statistically significant difference (Z =351.000,P＜0.05),and paclitaxel level of serum in the CPL group was lower than fluorouracil level of serum in the CFL group,showing a statistically significant difference (Z=577.000,P＜0.05).(2) Follow-up and survival:of 117 patients,21 lost follow-up,and 96 were followed up for 6.0-58.0 months,with a median time of 20.0 months.The 4-year cumulative survival rate in the CPL,CFL,FV and control groups was respectively 46.2％,27.8％,33.3％ and 17.1％.There was no statistically significant difference in the survival of 4 groups (x2 =5.166,P＞0.05).Conclusions The lymph node-targeted chemotherapy can promote chemotherapy drugs to aggregate in the lymph nodes during resection of esophageal carcinoma.The affinity of chemotherapy drugs on carrier is involved in clinical effects,and single use of chemotherapy drug cannot improve postoperative survival rate of patients.

Double layered anastomosis in thoracoscopic and laparoscopic esophagectomy / 中华胸心血管外科杂志

Objective To summarize the experience of double layered anastomosis in thoracoscopic and laparoscopic esophagectomy,and to explore its impact on the postoperative anastomotic complications.Methods Patients with thoracoscopic and laparoscopic esophagectomy from September 2014 to Auguest 2015 were retrospectively included.The cervical anastomosis were conducted by hand-sewn double layered anastomosis on the posterior wall of the gastric remnant,with the anastomotic configuration of end-to-side.The patients' general information and postoperative complications were recorded and analyzed.Results 45 patients with esophageal squamous cell carcinoma were included.The major postoperative complications were gastric dilatation(6/45,13.3％),hoarseness(5/45,11.1％),anastomotic leak/gastric necrosis(2/45,4.4％),anastomotic stricture(0/45,0).All patients were discharged from hospital with no perioperative death.Conclusion Hand-sewn double layered anastomotic technique could be safely used in thoracoscopic and laparoscopic esophagectomy,which could assure the security of the anastomosis.The anastomotic complication rates for this technique are rare enough to be recommended,as compared with other anastomotic methods reported in the literatures.

Comparison of mucosal reflux damage in remnant esophagus after esophagectomy and gastric interposition between Chinese and Canadian population / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the difference of mucosal damage in the remnant esophagus with similar postoperative reflux after esophagectomy and gastric interposition between Chinese and Canadian population.</p><p><b>METHODS</b>A prospective 1 to 1 paired study based on the same surgical approach was performed in Medical Centre of University of Montreal and West China Hospital of Sichuan University during the period from September 2010 to October 2013. The patients were followed up and evaluated by reflux symptom scoring, endoscopic assessment of mucosal damage, pathologic examination of biopsies and proliferation index test of esophageal epithelium.</p><p><b>RESULTS</b>Eighteen Han Chinese and 18 Caucasian Canadian patients with esophagectomy and gastric interposition were included in this study, with a follow-up period of 45 (28-67) months. There were no significant differences between the two groups in the incidence of postoperative reflux symptom, reflux symptom scoring, histological reflux esophagitis, erosion or stricture of remnant esophagus (all P>0.05). However, the incidence of mucosal metaplasia [44.4% (8/18) versus 11.1% (2/18), P=0.026], quantitative MUSE scoring [1.5 (1.0-2.0) versus 1.0 (0-2.0), P=0.042] and proliferation index [0.40 (0.30-0.45) versus 0.35 (0.30-0.50), P=0.038] of esophageal epithelium were significantly higher in Canadian patients than those in Chinese patients.</p><p><b>CONCLUSION</b>Under similar reflux situation, esophageal mucosa of Canadian population is more sensitive to the gastroesophageal reflux damage compared with Chinese population, resulting in more severe reflux damage of remnant esophagus in Canadian patients.</p>

Expressions of Notch signaling-associated proteins in esophageal squamous cell carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expressions and the role of Notch signaling-associated proteins in esophageal squamous cell carcinoma (ESCC).</p><p><b>METHODS</b>Fifty patients with ESCC were included in this study. The expressions of Notch signaling-associated protein (4 receptors: Notch1, Notch2, Notch3, Notch4; 5 ligands: Dll1, Dll3, Dll4, Jagged1, Jagged2) in cancer foci and adjacent normal tissues (5 cm distance to cancer) were examined by immunohistochemitry. Correlations of these proteins with cancer cell proliferation(Ki-67 index) and clinicopathologic features were investigated.</p><p><b>RESULTS</b>Higher levels of Notch1 and Notch2 were measured in cancer foci compared with adjacent tissues (all P<0.05). There were no differences in the expressions of Notch3, Dll1 and Dll3 (all P>0.05). Notch4, Dll4 and Jagged2 were not detected in both cancer foci and adjacent tissues. Notch1 expression was negatively correlated with lymph node metastasis and TNM staging (all P<0.01). Jagged 1 expression was positively correlated with TNM staging (P<0.01). Ki-67 index was obviously higher in cancer foci, while it was negatively correlated with Notch1 and Notch3 (all P<0.01) and positively correlated with Dll1 and Jagged 1 (all P<0.01).</p><p><b>CONCLUSION</b>Notch signaling path may act as tumor suppressive gene in the pathogenesis of esophageal squamous cell cancer, in which Notch1 protein plays an important role.</p>

Surgical treatment of lung cancer by video-assisted thoracoscopic surgery / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the role of curative and palliative surgical treatment of lung cancer with video-assisted thoracoscopic surgery (VATS).</p><p><b>METHODS</b>Forty-three patients with lung cancer were prescribed operations with VATS, which included 5 cases of stage IA, 14 cases of IB, 1 case of IIA, 4 cases of IIB, 7 cases of IIIA, 6 cases of T4-IIIB and 6 cases of IV. The 7 patients of stage IIIA were previously staged as N0 before operation, but reevaluated as N2-IIIA after operation. There were 3 cases of malignant pleural effusion and 3 cases of pleural implantation in stage IIIB cases. There were 2 cases of cardiac tamponade, 1 case of solitary brain metastasis, and 3 cases of ipsilateral or contralateral solitary lung metastasis in cases of stage IV. The main methods of operation performed included lobectomy in 36 cases, wedge resection in 5 cases, and pericardial opening in 2 cases. Systemly mediastinal lymph node dissections were performed in 36 cases. Concurrent contralateral pulmonary wedge resections were performed in 2 cases of contralateral solitary lung metastasis. Malignant pleural effusions were prescribed resection of implantation nodules, electrocautery and pleurodesis.</p><p><b>RESULTS</b>There was no perioperative death or bronchial leak. Five cases suffered lung infection, and 2 cases occurred with incision infection. Malignant pleural effusion in the 3 cases was controlled satisfactorily. Two cases of pericardial opening died in 4 months and 8 months after operation respectively. The other patients were alive till present. Postoperative hospital stay was 5-15 days with average of 7.4 days, except of two cases of pericardial opening.</p><p><b>CONCLUSIONS</b>VATS is an alternative way for complete resection of early stage lung cancer. It is technically feasible to dissect mediastinal lymph node for accidental N2 lung cancer. VATS has significant advantage in concurrent bilateral pulmonary resection. The palliative operation of malignant pleural effusion and cardiac tamponade by VATS can markedly improve the quality of life of patients.</p>

Diagnosis and treatment of pulmonary sclerosing hemangioma / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the diagnosis and treatment of pulmonary sclerosing hemangioma (PSH).</p><p><b>METHODS</b>The clinical features, radiographic manifestations and treatment of 21 patients with PSH were reviewed.</p><p><b>RESULTS</b>None of the 21 patients was diagnosed as PSH preoperatively. There were 18 females and 3 males, and the average age was 48.0 years in this group. Twelve patients were symptom free. The plain chest roentgenograms showed a well defined, homogeneous, round or oval nodulous shadow in most cases. All patients received operation. There was no postoperative morbidity and mortality. Postoperative follow-up showed a good prognosis.</p><p><b>CONCLUSIONS</b>Preoperative diagnosis of PSH is quite difficult. PSH should be suspected in middle to old aged female patients who show a well defined, homogeneous, round or oval shadow in plain chest roentgenograms. PSH has a good prognosis if it is treated surgically.</p>

Perioperative respiratory and circulatory features in overweighted patients with lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To analyze the perioperative respiratory and circulatory features of overweighted patients with lung cancer.</p><p><b>METHODS</b>The perioperative respiratory and circulatory features of 221 overweighted lung cancer patients were compared with those of 715 normal-weighted patients, by means of Chi-square analysis and t analysis.</p><p><b>RESULTS</b>The abnormal incidence of MBB, Raw, SGaw, PEF, FEV₁, V₇₅ , and EEG, blood presure, serum cholesterol and glucose, was significantly higher in overweighted group than that in the normal weighted group ( P < 0.05), and FRC was significantly lower than that of the normal weighted group (3.46±0.87 vs 3.63±1.17, P < 0.01). There was no difference in D LCO, MMEF, V₅₀ , V₂₅ between the two groups. The odds of postoperative complication in respiratory or circulatory system was significantly increased in overweighted group than that in the normal weighted group.</p><p><b>CONCLUSIONS</b>The obstruction of main airway, partial alveolar collapse and impotency of respiratory muscle may result in respiratory complication in overweighted patients, and increased cardiac burden and some pre-existing diseases in overweighted patients might be the cause of increased incidence of circulatory complication.</p>

The experimental study on the healing quality of the stoma in esophagogastrostomy by layering anastomosis / 中华胸心血管外科杂志

Objective To observe prespectively the healing quality in esophagogastrostomy anastomosis by layers. Methods The 12 dogs (adult male healthy hybrid dogs, group A) underwent esophagectomy with anastomosly layer. The anastomosis were observed grossly and histologic study was made on 5th, 8th, 14th, and 42th postoperative day (POD). The expression of the cytokines relating to wound healing such as epidermal growth factor(EGF), transforming growth factor ? 1(TGF ? 1) were detected (Immunohistochemistry, LsAB technique). Another 12 dogs underwent the intermittent whole layer with silk (group B). Results In group A, the stoma mucosa were in a better cooperation, soft, and had a thin scar. The count of the inflammation cells and fibroblast increased at the early period of postoperation (P