Lymph node evaluation in totally thoracoscopic lobectomy with two‑port for clinical early‑stage nonsmall‑cell lung cancer: Single‑center experience of 1086 cases.

OBJECTIVES: Although more and more video‑assisted thoracoscopic surgery (VATS) lobectomies via two‑port have been performed to treat early‑stage nonsmall‑cell lung cancer (NSCLC) in recent years, concern remains whether it can achieve satisfactory adequacy of lymphadenectomy. This retrospective study was aimed to evaluate the adequacy of lymphadenectomy by VATS via two‑port, compared with three‑port. MATERIALS AND METHODS: The clinical and pathological data of patients who underwent VATS lobectomy via two‑port or three‑port with systematic lymphadenectomy for clinical early‑stage NSCLC were reviewed. As the main evaluation criterion, the number of mediastinal nodes and node stations, and the total number of nodes and node stations was compared by approach. RESULTS: 1872 patients with NSCLC underwent VATS lobectomy, 1086 via a two‑port approach and 786 through a three‑port approach. In the two‑port and three‑port groups, the baseline patient characteristics were similar, and there was no significant difference in the mean number of dissected mediastinal lymph nodes (MLNs) (12.3 ± 2.2 and 13.1 ± 1.7, P > 0.05) and the mean number of dissected MLN stations (3.5 ± 0.7 and 3.4 ± 0.8, P > 0.05). Meanwhile, the mean total number of dissected lymph nodes (24.1 ± 4.2 and 25.7 ± 4.3, P > 0.05) and the mean total number of dissected lymph node stations (6.8 ± 1.3 and 6.9 ± 1.1, P > 0.05) were also similar. Otherwise, in terms of postoperative complications, there was no obvious difference in the two groups. CONCLUSIONS: The adequacy of lymphadenectomy including MLN dissection by VATS via two‑port is similar to that via three‑port for patients undergoing lobectomy for clinical early‑stage NSCLC.

Quality of life and survival after II stage nonsmall cell carcinoma surgery: Video‑assisted thoracic surgery versus thoracotomy lobectomy.

PURPOSE: Due to the improvement of thoracoscopic thchnology and surgeon’s ability, plenty of nonsmall cell lung cancer (NSCLC) was treated by video‑assisted thoracic surgery (VATS). This study was designed to evaluate the quality of life (QOL) and survival in II stage NSCLC patients following lobectomy, comparing VATS with thoracotomy. METHODS: Between 2010 and 2012, 217 II stage NSCLC patients (VATS: 114 patients, OPEN: 103 patients) were enrolled in a long‑standing, prospective observational lung cancer surgery outcomes study. Short‑form 36 health survey (SF‑36) and time to progression (TTP) were measured to evaluate the QOL and postoperative survival. RESULTS: There were significant differences between the two groups in the preoperative radiation therapy and differentiation, and the VATS group had less postoperative complication, blood loss, intraoperative fluid administration, and shorter length of stay. Statistical analysis of SF‑36 questionnaire revealed that VATS group score was higher on seven health dimensions: Bodily pain (BP), energy (EG), general health, physical functioning, mental health, SF, and role‑physical (RP), but only BP, EG, and RP have statistical significance. Using survival analysis, there was no significant difference between VATS and OPEN group, in which the mean TTP of VATS group is 18.5 months, while OPEN group is 20 months. CONCLUSIONS: VATS lobectomy tends to score higher on the QOL and functioning scales and has equivalent postsurgical survival compared with OPEN lobectomy for II stage nonsmall cell carcinoma patients.

Prognostic impact of CUG‑binding protein 1 expression and vascular invasion after radical surgery for stage IB nonsmall cell lung cancer.

BACKGROUND: Nonsmall cell lung cancer is the leading cause of cancer mortality worldwide because of distant metastasis and frequent recurrence. Only few reliable and easily accessible tumor markers have been clinically implemented to the early nonsmall cell cancer prognosis. OBJECTIVE: The purpose of this study is to detect the expression of CUG‑binding protein (CUGBP1) and assess the prognostic significance of CUGBP1 in early stage (IB) lung adenocarcinoma patients. MATERIALS AND METHODS: Using quantitative reverse transcription‑polymerase chain reaction (PCR) and immunohistochemistry (IHC) analysis, we detect the expression of CUGBP1 and assess their correlation with clinicopathological parameters by Chi‑square test. Time to progression (TTP) was used as a recurrent index and was evaluated by univariate and multivariate analysis in the Cox hazard model. RESULTS: Using PCR and IHC analyses, the expression of CUGBP1 and CUGBP1 messenger RNA (mRNA) had a close relationship with differentiation and vascular–invasion (VI). However, there were no significant differences between the CUGBP1 mRNA expression and CUGBP1 protein expression in IB lung adenocarcinoma. Using univariate and multivariate survival analyses, we found that CUGBP1 and VI were independent prognostic factors for IB stage adenocarcinoma individuals postsurgically. CONCLUSIONS: High expression of CUGBP1 could enhance the recurrence rate of adenocarcinoma and predicts an adverse postsurgical survival of TTP. Combination of CUGBP1 and VI detecting could be considered as indication to predict prognosis of IB stage adenocarcinoma in the clinical trial.

A modified method using a two-port approach for accessing the hilar vasculature without transferring an endostapler from camera port to utility port during thoracoscopic right upper lobectomy.

For thoracoscopic upper lobectomies, most cutting endostaplers must be inserted through the camera port when using a two-port approach. Access to the hilar vasculature through only the utility port remains a challenge. In this study, we describe a procedure to access the hilar vasculature without transferring the endostapler site during a thoracoscopic right upper lobectomy. A 2.5-cm utility anterior incision was made in the fourth intercostal space. The posterior mediastinal visceral pleura were dissected to expose the posterior portion of the right upper bronchus and the anterior trunk of the right pulmonary artery. The pleura over the right hilar vasculature were then peeled with an electrocoagulation hook. The anterior trunk of the right pulmonary artery was then transected with a cutting endostapler through the utility port firstly. This crucial maneuver allowed the endostapler access to the right upper lobe pulmonary vein. The hilar structures were then easily handled in turn. This novel technique was performed successfully in 32 patients, with no perioperative deaths. The average operation time was 120.6 min (range 75–180 min). This novel technique permits effective control of the hilar vessels through the utility port, enabling simple, safe, quick and effective resection.

A retrospective study of diaphragmatic motion, pulmonary function, and quality-of-life following video-assisted thoracoscopic lobectomy in patients with nonsmall cell lung cancer.

BACKGROUND: Diaphragmatic dysfunction and its negative physiologic disadvantages are less commonly reported in patients with lung cancer video‑assisted thoracoscopic lobectomy. The aim of this study was to investigate the outcomes of this complication on pulmonary function and quality‑of‑life in patients following video‑assisted thoracoscopic lobectomy. OBJECTIVES: The aim of this study was to investigate potential benefits on pulmonary function and quality‑of‑life with normal diaphragmatic motion. MATERIALS AND METHODS: A retrospective study was conducted in 64 patients with nonsmall cell lung cancer after video‑assisted thoracoscopic lobectomy. The population were divided into groups 1 (with diaphragmatic paralysis, n = 32) and group 2 (without diaphragmatic paralysis, n = 32) according diaphragmatic motion after postoperatively 6 months. And then, we investigated the difference between the two groups on pulmonary function and quality‑of‑life. RESULTS: (1) At 6 months after resection, the patients in group 1 had lost 25% of their preoperative forced expiratory volume in the 1 s (FEV1) (P < 0.001), and the patients in group 2 had lost 15% of their preoperative FEV1 (P < 0.001). And the other spirometric variables in group 1 were significantly worse than that of group 2 (P < 0.001). (2) The most frequently reported postoperative symptoms were fatigue, coughing, dyspnea, and thoracotomy pain in two groups. Of all the symptom scales, only the dyspnea scale showed a significant difference which subject has a higher proportion and scale compared to control. CONCLUSIONS: The present study indicates that unilateral diaphragmatic paralysis following video‑assisted thoracoscopic lobectomy caused adverse effects on postoperative pulmonary function and quality‑of‑life.

Anastomosis in minimally invasive Ivor lewis esophagectomy via two ports provides equivalent perioperative outcomes to open.

OBJECTIVE: Minimally invasive esophagectomy (MIE) is becoming a selective treatment of esophageal cancer; however, it’s a complex and technically demanding surgical operation. MIE can be performed in high volume centers in a variety of ways using different techniques. Transthoracic staplers have traditionally been used in open transthoracic Ivor Lewis Esophagectomy (ILE) with good success. An investigation of the safety and utility of transthoracic stapler via two ports on thorax for esophageal anastomosis in minimally invasive ILE is reviewed. METHODS: Patients of esophageal cancer were selected between November 2012 and July 2014. All the patients received minimally invasive (MIE) or open transthoracic ILE. Transthoracic stapler for MIE anastomosis was performed through the major port located at subaxillary region. Patients’ demographics, indications for esophagectomy, perioperative treatments, intraoperative data, postoperative complications, hospital length of stay, 7 and in-hospital mortality were evaluated. RESULTS: Totally, 63 consecutive patients underwent MIE or ILE. All the patients were Han with a mean age of 60 years (52–74). The indication of surgery is esophageal cancer, and squamous cell carcinoma was defined by pathologist before operation. None of the patients had neoadjuvant chemotherapy or radiation. All the MIE patients were no conversions to open thoracotomy or laparotomy. Mean operative time was 4.5 h. One patient (3.03%) suffered postoperative pneumonia, no leak from the gastric conduit staple line or esophageal anastomoses, no postoperative complication required surgical intervention was observed. The median hospital length of stay was 13 days (range 7–18). There were no in-hospital mortalities. CONCLUSIONS: In our study, transthoracic stapler through the major port at subaxillary seems technically feasible and safe for minimally invasive ILE with comparable morbidity and oncologic data to open.

Two-incision approach for video-assisted thoracoscopic sleeve lobectomy treating the central lung cancer.

BACKGROUND: We review our experiences with video‑assisted thoracoscopic surgery (VATS) sleeve lobectomy with bronchoplasty for nonsmall‑cell lung cancer, using only two incisions. The aim of this study was to evaluate the technical feasibility and safety of surgical approach. MATERIALS AND METHODS: From January 2013 to January 2014, we completed 15 cases of VATS sleeve lobectomy with bronchoplasty in our hospital. The patients underwent sleeve lobectomy with bronchoplasty at the following locations: right upper lobe (n = 4), right lower and middle lobes (n = 1), left lower lobe (n = 5), and left upper lobe (n = 6). The operation consisted of VATS anatomic sleeve lobectomy with bronchoplasty combined with systematic lymph node dissection, using only two incisions. RESULTS: The patients underwent sleeve lobectomy with bronchoplasty were no postoperative complications. Median operative time was 183 min; median bronchial anastomosis time was 39 min; median blood loss was 170 ml. Pathological examination showed 12 squamous cell carcinomas and 3 adenocarcinoma. Median postoperative chest tube drainage duration was 4.5 days, and median hospital stay was 6.9 days. CONCLUSIONS: Video‑assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty is a feasible and safe surgical approach, using only two incisions. This way of operation can promote the development of surgical technology.

Computed tomography-guided iodine-125 interstitial implantation as an alternative treatment option for lung cancer.

PURPOSE: The aim was to evaluate the safety, feasibility and efficacy of computed tomography (CT)‑guided percutaneous interstitial brachytherapy using radioactive iodine‑125 (125I) seeds for the treatment of lung cancer. MATERIALS AND METHODS: Included in this study were 45 male and 35 female patients aged 52–85 years (mean 72‑year) who were diagnosed with lung cancer. Of the 80 cases of lung cancer, 38 were pathologically confirmed as squamous cell carcinoma, 29 as adenocarcinoma, 2 as small cell lung cancer, and 11 as metastatic lung cancer. Percutaneous interstitial implantation of radioactive 125I seeds was performed under CT guidance. The treatment planning system was used to reconstruct three‑dimensional images of the tumor to determine the quantity and distribution of 125I seeds to be implanted. Under CT guidance, 125I seeds were embedded into the tumor, with the matched peripheral dose set at 100–130 Gy. Follow‑up CT scan was done in 2‑month to explore the treatment efficacy. RESULTS: The procedure was successful in all patients. No major procedure‑associated death occurred. The duration of follow‑up was 6‑month. Complete response (CR) was seen in 38 cases (47.5%), partial response (PR) in 27 cases (33.75%), stable disease (SD) in 10 cases (12.5%), and progressive disease in 5 cases (6.25%), with a local control rate (CR + PR + SD) of 93.75%. The 2‑, 4‑ and 6‑month overall response rate (CR + PR) was 78%, 83% and 81%, respectively. CONCLUSION: Implantation of CT‑guided 125I seeds is a safe and effective alternative option for the treatment of lung cancer.