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Objective:To discuss the safety and feasibility for the use of 3D uniportal VATS sleeve resection.Methods:Totally 32 patients with central lung cancer received 3D uniportal VATS sleeve resection(group A) from June 2017 to May 2020 at Shanghai Chest Hospital. Meanwhile, 63 patients received conventional VATS sleeve resection(group B). The clinicopathological and perioperative outcome data were retrospectively collected and analyzed.Results:The baseline clinicopathological characteristics between these two groups were statistically similar. Compared with group B, the mean operative time[(174.19±73.69)min vs.(212.46±50.02)min, P=0.004] and blood loss[(73.13±42.70)ml vs.(130.48±133.72)ml, P=0.020] of group A were decreased, harvested lymph node stations was increased(7.63±1.59 vs. 6.76±1.70, P=0.018). Lymph nodes dissected showed no statistical difference(1.31±1.58 vs 1.21±1.96, P=0.803). There was no intraoperative death in both groups. Inspiringly, group A possessed lower rate of conversion to thoracotomy(0 vs. 36.5%, P=0.000), shorter chest drainage durations[(4.88±1.15)days vs.(6.81±3.8)days, P=0.007]. Although there were no deaths during hospitalization in both groups, the incidence of postoperative complications in group A was significantly lower than that in group B(25.0% vs. 47.6%, P=0.046). It also presented more complicated operations including pulmonary artery plasty(25.0% vs. 6.3%, P=0.024) and carina plasty(12.5% vs. 1.6%, P=0.005) against group B. Conclusion:3D uniportal VATS was a safe and feasible technique for the surgical treatment of central lung cancer when conducting a thoracoscopic sleeve resection.
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Objective As the population ages,clinicians are increasingly confronted with octogenarians with early-staged non-small cell lung cancer(NSCLC).We reviewed the outcomes of octogenarians who underwent lobectomy for clinical stagc Ⅰ NSCLC,to determine whether there was a benefit to the VATS approach in this group,and to analysis the risk factors of complication and survival.Methods We conducted a retrospective single-institution review of patients age 80 years or greater who underwent lobectomy for NSCLC from January 2006 to December 2016.Clinical outcomes including complication rate and survival rate were analyzed.Results 162 octogenarians underwent lobectomy:98 VATS and 64 through open thoracotomy.Compared with thoracotomy,VATS patients had fewer complications (14.3 ％ vs.28.1％,P =0.03),shorter length of tube duration [(3.5 ± 1.5) days vs.(4.9 ± 2.0) days,P =0.04],and shorter length of stay [(5.5 ± 2.1) days vs.(7.8 ± 3.5) days,P =0.04].For patients with pathologic stage Ⅰ disease,the 5-year overall survival was 64.5％,for stage Ⅱ was 38.1％,and for stage Ⅲ was 20.1％.The 5-year overall survival rates of pathological stage Ⅰ and stage Ⅱ,Ⅲ are of significant differences(P =0.001).In a multivariate logistic regression analysis,the approach of thoracotomy emerged as an independent predictor of complication (OR =1.94,95％ CI 1.214-5.135,P =0.03).In a multivariate COX regression analysis,pathological stage(OR =2.01,95％C1 1.453-5.865,P=0.03) and ASA(OR =1.81,95％CI 1.188-4.015,P =0.04) are independent predictors of over survival.Conclusion Octogenarians with NSCLC can undergo resection with low mortality and survival among stage Ⅰ patients,which is comparable with the general lung cancer population.The VATS approach reduces morbidity in this age demographic,resulting in shorter length of tube duration and shorter stay,while the approach of thoracotomy is an independent predictor of complication.Our study also demonstrated that pathological stage and ASA are independent predictors of overall survival rate.
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<p><b>OBJECTIVES</b>To evaluate the efficacy and advantage of minimally invasive esophagectomy for surgical treatment of submucosal esophageal cancer compared to conventional open procedure.</p><p><b>METHODS</b>Clinical data of consecutive 168 patients with stage T1b submucosal esophageal cancer undergoing minimally invasive esophagectomy (MIE, esophagectomy by thoracoscope, stomach freeing by laparoscope or open abdomen, cervical esophagogastric anastomosis) or conventional open esophagectomy (OE) at the Shanghai Chest Hospital between January 1, 2012 and December 31, 2014 were reviewed retrospectively. Intraoperative and postoperative information was compared between the two groups.</p><p><b>RESULTS</b>Both groups were equally stratified by sex, body mass index and age. No patient of MIE group was transferred to open operation. As compared to the OE group, the MIE group had significantly more harvest lymph nodes (median 12 vs. median 9, P=0.004), lower rate of postoperative pneumonia [5.8% (4/69) vs. 21.2% (21/99), P=0.011] and pleural effusion [8.7% (6/69) vs. 23.2% (23/99), P=0.027], and shorter hospital stay (median 11 d vs. median 14 d, P=0.041), but positive margin was found in 1 case. There were no significant differences of respiratory failure, pneumothorax, atrial arrhythmia, pulmonary embolism, recurrent nerve palsy, anastomotic leak, reoperations and 30-day mortality between the two groups. Multivariate logistic analysis revealed recurrent nerve palsy, anastomotic leak and surgical approach were found to be the main factors of hospital stay within postoperative 12 days, while leakage when the in-hospital time more than 12 days. Kaplan-Meier analysis showed that the surgical approach was the independent factor of hospital stay, MIE could shorten the hospital stay (P=0.013).</p><p><b>CONCLUSION</b>MIE should be considered as the standard approach in the treatment of T1b submucosal esophageal cancer.</p>
Subject(s)
Humans , Anastomotic Leak , China , Esophageal Neoplasms , General Surgery , Esophagectomy , Kaplan-Meier Estimate , Laparoscopy , Length of Stay , Minimally Invasive Surgical Procedures , Operative Time , Postoperative Complications , Retrospective StudiesABSTRACT
ObjectiveTo retrospectively investigate the clinical results of video-assisted thoracoscopic surgery for pulmonary pure ground-glass opacity.MethodsThe clinical data of 45 patients with pGGO underwent video-assisted thoracoscopic surgery were collected.The gender constitution,age,smoking status,surgical procedures,lesion size,histological types of tumor,lymph node metastasis and prognosis were retrospectively analyzed.ResultsThe numbers of females and non-smokers were significantly larger than those of males and smokers.All 45 patients underwent video-assisted thoracoscopic surgery.37 patients of solitary pGGO were all operated with cure intention.27 of the 37 patients received local resection ( wedge resection in 18 or segment resection in 9),and the other 10 patients underwent lobectomy.There are 8 patients of multiple nodes.Amongthese,6 were operated with cure intention,while 2 received VATS biopsy.Pathological examinations after operation revealed that there were 31 cases of bronchioloalveolar carcinoma and 14 cases of atypical adenomatous hyperplasia.And there was no lymph node metastasis.The diameters of bronchioloalveolar carcinoma lesions were significantly longer than those of atypical adenomatous hyperplasia lesions( P ＜ 0.05 ).Patients were followed up for 4 months to 6 years,and all survived without local recurrence and distant metastasis.ConclusionThe diameters of bronchioloalveolar carcinoma lesions are longer than those of atypical adenomatous hyperplasia lesions.Video-assisted thoracoscopic sublobectomy for pulmonary pure ground-glass opacity may achive excellent clinical results.Computed tomography-guided localization is a useful,safe procedure.
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ObjectiveTo evaluate prognostic factors and the surgical results of pulmonary carcinoid tumors.Methods We retrospectively reviewed the medical records of 62 patients who were diagnosed as pulmonary carcinoid tumors between January 2000 and October 2010 at Department of Thoracic Surgery,Shanghai Chest Hospital.The following information was available for each of the 62 patients:age,sex,pathological type,and TNM stage.ResultsThere were no operative death.The 3-year and 5-year survival rates after surgery were 92.1％ and 77.8％,respectively.Of the 62 patients,42 were diagnosed as typical carcinoid tumor,and among them,4 patients (8.3％) had lymph node metastases.Their 3-year and 5-year survival rates were 97.8％ and 94.7％,respectively.The remaining 20 patients were diagnosed as atypical carcinoid tumor,and among them,6 patients (37.5％) had lymph node metastases.Their 3-year and 5-year survival rates were 84.4％ and 58.8％,which were statistically significant compared with typical carcinoid tumor( P =0.0047 ).There was significant difference in survival rate between the patients with lymph node metastases and the patients without lymph node metastases (P =0.0048).CondusionThe main risk factors affecting survival rate of those patients who were diagnosed as pulmonary carcinoid tumors were pathological types and lymph node metastases.
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Objective To study the distribution and clinicopathological characteristics between VEGF-C and pefitumoral lymph vessels density(PLVD) in breast cancer tissue, and to investigate the development and the mechanism of breast cancer-related lymphoedema (BCRL). Methods VEGF-C and VEGFR-3 were detected by using immunohistochemical technique for the detection of VEGF-C and its receptor VEGFR-3 in forty-seven breast cancer specimens. We measured the patients' circumferences of bilateral upper limbs to determine whether there was lymphoedema and made classification in the follow-ups. Results VEGF-C was positive in 33 out of 47 cases. PLVD significantly increased in VEGF-C positive groups (30.39±10. 46) than in negative groups (23.16±11.67) (P<0.05). VEGF-C semi-quantitative score was in a positive correlation with PLVD (r=0.334). The positive expression rate (42.55%) and semi-quantitative score (3.68±1.59) of VEGF-C increased in the lymph node positive group than in the negative group, PLVD increased in the lymph node positive group compared with that in negative group (32.12±10.29 vs. 24.82±11.06), P<0.05. The risk of lymphoedema increased in the VEGF-C negative group (5/14) compared with that in the positive group (3/33) (P<0.05). Conclusion VEGF-C has a high rate of positive expression in breast cancer, and is positively correlated with PLVD. High expression of VEGF-C can reduce the risk of BCRL in breast cancer.