Thoracoscopy and thoracotomy for lung biopsy and wedge resection in solitary pulmonary nodule / 中国肺癌杂志

<p><b>BACKGROUND</b>Lung wedge resections and biopsies are frequently needed to diagnose and treat benign or malignant lung lesions. This study aims to compare thoracoscopy with thoracotomy for lung biopsy and wedge resection in solitary pulmonary nodule (SPN).</p><p><b>METHODS</b>A controlled retrospective study was performed in this hospital. Patients with clinical diagnosis of SPN were undergone thoracoscopy or thoracotomy. Data of operation time, hours of stay in recover room, duration and volume of chest tube drainage, accuracy of biopsies, days of hospitalization and the whole cost of hospitalization were evaluated.</p><p><b>RESULTS</b>All patients were received lung biopsies and wedge resections (thoracoscopy 26,thoracotomy 47), and they were diagnosed pathologically. The days of hospitalization were similar in the two groups. The minutes of operation had no significant difference (thoracoscopy: 103.9±29.4 minutes, thoracotomy: 94.7±33.9 minutes). Both groups had equivalent duration of chest tube drainage (thoracoscopy: 60.3±25.0 hours, thoracotomy: 62.5±20.1 hours, P =0.687) . The total volume of chest tube drainage showed no difference in both groups. The hours of stay in recover room (thoracoscopy: 75.4±21.6 hours, thoracotomy: 80.4±17.7 hours, P =0.287) and days of hospitalization after operation (thoracoscopy: 11.3±3.4 days, thoracotomy: 10.6±2.4 days, P = 0.304 ) were not different significantly. The whole cost of thoracoscopy was 17 800.2±6 038.9 CNY and thoracotomy was 17 677.4±6 327.8 CNY ( P = 0.936 ).</p><p><b>CONCLUSIONS</b>There is no significant difference in outcomes for thoracoscopy and thoracotomy approaches. Both thoracoscopy and thoracotomy are acceptable procedures for lung biopsy and wedge resection in solitary pulmonary nodules.</p>

Diagnosis and surgical treatment of esophageal leiomyoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the characteristics of diagnosis and surgical treatment of esophageal leiomyoma.</p><p><b>METHODS</b>Preoperative radiology, esophagoscopy and results of surgical treatment were retrospectively analyzed in 141 patients with esophageal leiomyoma.</p><p><b>RESULTS</b>Dysphagia (64.5%) and chest or epigastric pain (20.6%) were the most common presenting symptoms with a mean duration of 15.7 months. Eleven patients had been misdiagnosed as malignant esophageal disease, mediastinal or retroperitoneal tumor before operation. Thirteen patents received partial esophageal resection, including 2 patients with gigantic tumor, 3 still misdiagnosed as malignancy in the operation theater and 8 accompanied with esophageal or gastric cardiac carcinoma. 128 patients were treated with tumor removal only, among whom the esophageal mucosa was ruptured and sutured in 13 patents. The tumor was single in 130 patients and multiple in 11 patients. The tumor shape was either oval, horseshoe-or ginger-like. Tumor surrounded the esophagus less than half circumference in 75 patients, more than half in 59 patients and involved the whole circumference in 7 patients. The tumor was polypoid and intraluminal in one patient. It was extraluminal in 2 patients and was intramural in all the others. The morbidity and 30-day mortality rates were 3.6% and 0%.</p><p><b>CONCLUSION</b>Preoperative differentiation of esophageal leiomyoma is important for it may be misdiagnosed as esophageal malignant disease or mediastinal tumor. Tumor removal only is indicated if possible. Biopsy is inadvisable if leiomyoma has been suspected by esophagoscopy. The incidence of esophageal carcinoma complicating esophageal leiomyoma is high, of which the reason needs further study.</p>

99mTc-Pingyangmycin imaging in the diagnosis of primary lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of (99m)Tc-Pingyangmycin (PYM) imaging for the diagnosis of primary lung cancer.</p><p><b>METHODS</b>Radionuclide (99m)Tc-Pingyangmycin (PYM) imaging was performed in 56 patients with pulmonary lesions.</p><p><b>RESULTS</b>The uptake ratio and retention index (RI) were different in malignant and benign lesions. With the delayed ratio regarded as the threshold for lung cancer, the overall accuracy, sensitivity and specificity of (99m)Tc-PYM in the diagnosis of lung cancer were 82.1%, 82.7% and 80%, respectively. If RI was regarded as the threshold, the overall accuracy, sensitivity and specificity were 94.6%, 93% and 100%, respectively. There was no significant difference among different histological types of the lung carcinoma.</p><p><b>CONCLUSION</b>(99m)Tc-PYM, as a good imaging agent, is useful in differentiating malignant lung lesions from benign ones.</p>

Surgical treatment for lung cancer patients with poor pulmonary function / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarize surgical treatment of lung cancer patients with poor pulmonary function.</p><p><b>METHODS</b>From 1991 to 1999, 181 lung cancer patients with poor pulmonary function underwent operation. The correlation between the results of preoperative pulmonary functional tests and the postoperative cardiopulmonary complications was analyzed by Chi-square test (chi(2)).</p><p><b>RESULTS</b>In 181 patients, pneumonectomy was done in 43, lobectomy in 118, partial lung resection in 16 and exploration in 4. The postoperative complication and mortality rates of the resection group were 42.3% (75/177) and 7.9% (14/177). The cardiopulmonary complication rates were 25.6%, 48.3%, 31.3% in pneumonectomy, lobectomy and partial lung resection. The morbidity and mortality rates of 8 patients who received preoperative chemotherapy and/or radiotherapy were 75.0% and 37.5%. The morbidity and mortality rates of 12 patients who had had a previous history of thoracotomy were 66.7% and 33.3%. In the present series, the 1-, 3- and 5-year survival rates were 71.1%, 42.2% and 31.1%. The 5-year survival rates of patients with stage I, II and III lesions were 55.0%, 25.0% and 0.</p><p><b>CONCLUSION</b>Preoperative spirometry is an important evaluation test for lung cancer patients with poor pulmonary function. It should be evaluated in combination with other pulmonary function tests such as CO(2) diffusion and cardiopulmonary excise tests, etc whenever possible. Patients with a history of thoracotomy, chemotherapy and radiotherapy should be carefully evaluated before operation to avoid high morbidity and mortality. Stage I and II lung cancer patients with poor pulmonary function can undergo operation if they have been well managed preoperatively and well taken care of with nursing care perioperatively.</p>

Clinical value of prophylactic radiotherapy after curative resection of esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of prophylactic radiotherapy for esophageal carcinoma after curative operation.</p><p><b>METHODS</b>495 esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery alone group (S, 275) and a surgery plus radiotherapy group (S + R, 220). Radiation treatment was started 3 - 4 weeks after operation. The portals encompassed the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50 approximately 60 Gy in 20 approximately 30 fractions over 5 approximately 6 weeks was delivered.</p><p><b>RESULTS</b>1. Survival rate: the overall 5-year survival rate was 39.4%. Those of S alone and S + R groups were 37.1% and 41.3% (P = 0.447 4). The 5-year survival rate for Stage III patients were 13.1% in S alone group and 35.1% in R + S group (P = 0.002 7), 2. Pattern of failure: The incidence of local recurrence intra-thoracic lymph node metastasis, anastomotic recurrence and extra-thoracic lymph node metastasis in S + R group (16.2%, 0.5% and 3.1%) were lower than those (25.9%, 5.8% and 13.2%) (P < 0.05) in S alone group and 3.</p><p><b>COMPLICATIONS</b>the anastomotic stricture frequencies were similar in the two groups (S 1.8%; S + R 4.1%).</p><p><b>CONCLUSION</b>1. Prophylactic radiotherapy is able to improve the survival rate of stage III patients treated by radical resection, 2. Postoperative radiotherapy is able to reduce the incidence of failure by recurrence in the intra-thoracic lymph nodes and anastomotic recurrence to where radiation therapy had been given, 3. Postoperative radiotherapy does not increase the incidence of anastomotic stricture.</p>

Management of perioperative respiratory problems in patients with tumor of trachea or carina / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarise and analyse the experience and methods of managing the perioperative respiratory problems in patients with tumor of trachea or carina surgically treated during the last decade, and the ways of preventing severe postoperative respiratory complications in the future.</p><p><b>METHODS</b>Thirty-eight patients with tumor of trachea or carina surgically treated from 1991 to 2000 by different modes of tracheobronchial plastic surgery were retrospectively studied to summarise and analyse the changes in preoperative pulmonary function, postoperative complications and the management of perioperative respiratory problems.</p><p><b>RESULTS</b>Out of 38 patients, 29 (76.3%) gave abnormal results to preoperative pulmonary function tests. 55.3% (21/38) of the whole series developed 45 postoperative complications with respiratory complications as the major one (80.0%). Seventeen patients who had undergone carinal pneumonectomy or carinal resection plus reconstruction gave far more complications (28 complications) than the remaining 21 patients treated by other modes of surgery (17 complications). Four patients died of postoperative complications with a mortality rate of 10.5%.</p><p><b>CONCLUSION</b>Patients treated with carinal pneumonectomy or carinal resection plus reconstruction give much more complications than patients treated by any other modes of large airway surgery. Fiberoptic bronchoscopic (FOB) guided intubation, precise surgical treatment, postoperative mechanical ventilation support, use of effective antibiotics and sufficient nutritional support are important for a successful management of these patients.</p>

Management of chylothorax after pulmonary resection / 中国癌症杂志

Purpose:To study the diagnosis and management of postoperative chylothosax for resection of lung cancer.Methods:Clinical data of 8 patients with lung cancer who had postoperative chylothorax were analyzed retrospectively. Results:4 cases were treated by conservative treatment, among them 2 cases were cured, the other 2 cases had respiratory failure. The rest were cured by tieing off the ductus thoracicus. Conclusions:It is suggested that in the management of postoperative chylothorax, conservative treatment or tieing off the ductus thoracicus, depending on the patients' condition.