Clinical therapeutic effect of esophageal carcinoma with hand video assisted surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical therapeutic effect of esophageal carcinoma with hand video assisted surgery.</p><p><b>METHODS</b>Forty cases which C TNM stage was T3N1M0 received hand video assisted surgery (HVATS group), 40 cases received routine operation (control group). Recurrence survival analysis of each group was analyzed with SPSS10.0 software according to the date of the stage and survival rate.</p><p><b>RESULTS</b>All group have satisfied surgical result. All patients have good quality of life. The 3 year survival rate was 52.7% in HVATS group and 51.3% in control group. The difference of survival rate was no significance.</p><p><b>CONCLUSION</b>Hand video assisted surgery for esophageal carcinoma had same result as routine thoracic operation. Short operation time, less trauma and fast recovery are the advantages of hand video assisted surgery.</p>

A prospective longitudinal study examining the impact on short term quality of life of hand video-assisted thoracoscopic surgical esophagectomy in patients with esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of hand video-assisted thoracoscopic surgery (HVATS) and Ivor-Lewis surgery on short term quality of life (QL) of patients with esophageal cancer.</p><p><b>METHODS</b>Thirty-nine consecutive patients with esophageal cancer were classified into HVATS group (n = 21) and Ivor-Lewis group (n = 18) randomly, all patients completed the Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 before treatment and at regular intervals until 6 months after operation. MEAN scores were calculated for every patient.</p><p><b>RESULTS</b>Baseline functional and symptom QL MEAN scores were similar in both groups. All patients reported worse functional, symptom and global QL scores (QOL) within 6 months after operation than before. HVATS group gained higher functional, global QL scores and lower symptom scores than Ivor-Lewis group, moreover, patients' QL scores of HVATS group returned to preoperative levels more quickly than those patients in Ivor-Lewis group. Significant differences were found in global health (QOL), physical functioning, fatigue and pain scales between groups. In both groups, QLQ-OES18 dysphagia scales were improved after surgery,but no significant differences were found at scales respect to esophageal cancer.</p><p><b>CONCLUSIONS</b>HVATS esophagectomy is a safe procedure which has a low disturbance to patients' short term Quality of Life compared with Ivor-Lewis esophagectomy. It might seem reasonable to choose HVATS esophagectomy for patients with early stage esophageal cancer.</p>

18F-FDG uptake as a biologic factor predicting outcome in patients with resected non-small-cell lung cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The outcome of surgical treatment of non-small-cell lung cancer (NSCLC) remains poor. In many patients the biological behavior of NSCLC does not follow a definite pattern, and can not be accurately predicted before treatment. (18)F-fluoro-2-deoxy-glucose ((18)F-FDG) uptake on positron-emission tomography (PET) is associated with the aggressiveness of NSCLC. The present study focused on the role of (18)F-FDG uptake in predicting the outcome of surgically treated patients with NSCLC.</p><p><b>METHODS</b>A retrospective analysis was made of 82 patients who underwent complete resection and preoperative FDG PET. The maximum standardized uptake value (SUV(max)), in addition to five clinicopathological factors and three biomolecular factors, which could possibly influence survival, was compared for possible association with patients' recurrence and survival, by the Log-rank test in univariate analysis and the Cox proportional hazards model in multivariate analysis. The association between SUV(max) and other factors was also analyzed.</p><p><b>RESULTS</b>Patients with SUV(max) more than 11 had a disease-free survival and overall survival shorter than patients with SUV(max) less than 11 in univariate analyses (P < 0.001, P = 0.002). In the multivariate analysis, SUV(max) (dichotomized by 11) was the only significant predictor for tumor recurrence. TNM stage and SUV(max) (dichotomized by 11) were independent predictors for the overall survival. Associations of SUV(max) with p53 overexpression, proliferating cell nuclear antigen (PCNA) labeling index and microvascular density of the tumor were significant in the entire group.</p><p><b>CONCLUSIONS</b>(18)F-FDG uptake on PET may be used to noninvasively assess biological aggressiveness of NSCLC in vivo, identifying the surgically-treated patients with poor prognosis who could benefit from additional therapy.</p>

Resection for lung cancer invading the superior vena cava / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the feasibility and the value of resection for lung cancer invading the superior vena cava (SVC).</p><p><b>METHODS</b>Between 1988 and 2005 the data of 31 patients who underwent resection were analyzed retrospectively. The reconstruction was done using simple suture, pericardial patch or prosthetic replacement. Postoperative morbidity, long-term survival were examined using the Kaplan-Meier method (Log rank test) and the COX model for survival.</p><p><b>RESULTS</b>Seventeen squamous cell carcinomas, 8 adenocarcinomas, and 6 undifferentiated small cell carcinomas were resected. There were 13 partial SVC resection, the reconstruction was done using a simple running in 5 patients, and a pericardial patch in 8 patients. Eighteen patients underwent complete resection of SVC with prosthetic replacement. The time of clamping the SVC system was from 8 to 35 minutes for complete resection patients, while the time was from 3 to 15 minutes for partial resection patients. One patient didn't clamp the SVC. Postoperative morbidity and mortality were 48% and 0%, respectively. One, 3 and 5-year survival rates were 61%, 33% and 21%, respectively, with median survival at 31 months. Survival rate of patients with N2 disease was obviously lower than those with localized (N0/N1) nodal disease (chi2 = 14.3, P = 0.000), the median survival was 42 and 13 months respectively. There were no significant effects on overall survival with pathologic features and surgery methods. Survival rate of patients with induction chemotherapy before operation or intraoperative chemotherapy was higher than those received direct surgery (chi2 = 5.0, P = 0.025), the median survival was 39 and 14 months respectively.</p><p><b>CONCLUSIONS</b>The resection of the SVC for involvement by lung cancer can be performed in selected patients, especially for those with localized (N0/N1) nodal disease. Induction chemotherapy should be performed.</p>

The role of 11C-choline positron emission tomography-computed tomography and videomediastinoscopy in the evaluation of diseases of middle mediastinum / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography (PET) of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography (CT), and PET-CT in patients with mediastinal disease.</p><p><b>METHODS</b>Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. (11)C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value (SUV) and were compared with pathologic data.</p><p><b>RESULTS</b>There were 13 men and 19 women aged from 21 to 74 (mean 45.2) years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical "sarcoid" finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative (the pathological diagnosis was reactive hyperplasia). The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% (12/32), 63% (20/32), and 91% (29/32) respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT (chi(2) = 11.130, P < 0.001). The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% (17/32), 75% (24/32), 100% (32/32) respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT (chi(2) = 22.042, P < 0.001). The SUV of malignant lesions (6.9, 3.2 - 9.8; n = 11) appeared to be higher than that of benign lesions (4.9, 2.9 - 8.3; n = 21), however, this difference was not statistically significant (P = 0.054).</p><p><b>CONCLUSIONS</b>To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone (SUV) may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.</p>

Hand-assisted video-thoracoscopy for resection of esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and advantages of hand-assisted video-thoracoscopy for resection of esophageal cancer.</p><p><b>METHODS</b>Forty-five patients with esophageal cancer received hand-assisted video-thoracoscopic esophagectomy (group I). 45 patients underwent esophagectomy through routine open thoracotomy during the same period as control (group II). The data of lymph node resection, operating time and blood loss were compared.</p><p><b>RESULTS</b>There were no operative mortality in 2 groups. In group I, the number of dissected paraesophageal lymph nodes, cardiac lymph nodes and left gastric nodes were (3.6 +/- 1.0), (1.3 +/- 1.1) and (4.3 +/- 1.4), respectively. While for group II the dissected lymph nodes were (3.3 +/- 1.5), (1.6 +/- 1.1) and (4.7 +/- 2.1), respectively. There was no significant difference between two groups (P > 0.05). However, the number of dissected mediastinal nodes was (6.6 +/- 3.7) for group I and (3.8 +/- 2.5) for group II (chi(2) = 2.95, P < 0.05). The mean operating time was (29 +/- 5) minutes for group I and (60 +/- 6) minutes for group II. The mean blood loss was (93 +/- 19) ml for group I and (145 +/- 35) ml for group II. The mean chest tube drainage was (201 +/- 45) ml for group I and (295 +/- 57) ml for group II in the first postoperative day. The difference in above parameters between 2 groups was significant (chi(2) = 18.69, 6.13, 6.08, P < 0.001).</p><p><b>CONCLUSIONS</b>It is suggested that hand-assisted video-thoracoscopic esophagectomy is a safer, minimal invasive procedure in the resection of esophagus carcinoma.</p>

The clinical significance of vascular endothelial growth factor and intercellular adhesion molecule-1 expression in non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1), and their relationship to behaviors of the non-small-cell lung cancer.</p><p><b>METHODS</b>The study included 86 patients with non-small-cell lung cancer. A rapid immunohistochemical method (streptoavidin-peroxidase, SP) was used to detect VEGF and ICAM-1 expression. All patients were treated surgically and without preoperative radio- or chemotherapy.</p><p><b>RESULTS</b>The positive expression of VEGF was significantly correlated with the lymph node metastasis, TNM stage, prognosis and hematogenous tumor metastasis positively, but ICAM-1 was negatively. For patients with positive expression of VEGF and negative expression of ICAM-1, the 5-year survival rate was the lowest in all patients.</p><p><b>CONCLUSIONS</b>The expression of VEGF and ICAM-1 correlates with the malignant behavior of non-small-cell lung cancer. Examination of VEGF and ICAM-1 in non-small-cell lung cancer may help to evaluate its intensity of lymph node metastasis, TNM stage and prognosis. VEGF and ICAM-1 may play an important role in the development and metastasis of non-small-cell lung cancer.</p>

Application of stair climbing test in preoperative evaluation for patients of lung cancer with lower pulmonary function / 中华全科医师杂志

0.05). Significant difference in diffused carbon monoxide percentage and change of heart rates before and after stair climbing test was found in LPF group (P0.05).Conclusions Patients of lung cancer intolerable for lobectomy by static pulmonary function test can be screened by stair climbing test before surgical operation,which can make some of them regain opportunity of surgical operation.

The effect of postoperative chemotherapy after esophagectomy on the survival rate to patients with original squamous cell carcinoma of esophagus / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the prognostic factors affecting the survival rate after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma and the effect of postoperative chemotherapy.</p><p><b>METHODS</b>Out of 126 patients with original squamous cell carcinoma of esophagus who accepted extended radical esophagectomy with three-field lymph node dissection from 1987 - 1992 in a hospital, 97 of them were included in this study. Data on the clinical/pathological characters and post surgery survival records of the subjects' were collected. Survival analysis methods included Kaplan-Meier, Log-rank test and Cox multivariable model and the effects of postoperative chemotherapy were analyzed for patients in early and late stages.</p><p><b>RESULTS</b>There was no significant difference in clinical and pathological character between those patients only undergone surgery and patients accepting postoperative chemotherapy. The size of tumor, grade of differentiation of the tumor cells, infiltration deepness, with or without lymph node metastasis, expression of nm23 and EGFR and treatment after surgery etc. were correlated with the survival rate. For patients in early tumor stage, postoperative chemotherapy with cisplatin and 5-FU after surgery seemed to be a risk factor. For patients in late stage, postoperative chemotherapy with cisplatin and 5-FU after surgery did not seem to improve survival rate.</p><p><b>CONCLUSION</b>It is imperative to study on the effect of adjuvant postoperative chemotherapy to patients, especially those at early stage with squamous cell carcinoma of esophagus. Doctors must be scrupulous when making decisions.</p>

A study of correlation between early postoperative relapse with lymph node micrometastasis in patients with N0 esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the correlation between early postoperative tumor relapse with lymph node micrometastasis in the patients with pN(0) esophageal cancer.</p><p><b>METHODS</b>Using reverse transcriptase-polymerase chain reaction (RT-PCR), one hundred and sixty-six regional lymph nodes obtained from forty-three patients with esophagus cancer without invasion of the tumor confirmed by histopathologic analysis (pN(0)) were studied for further detecting mRNA of Mucin1 (MUC1) gene and determining nodal micrometastasis. All the patients underwent radical resection and regional lymph node dissection. Patients were followed up for one year to detect early tumor relapse. Difference in relapse was compared by chi(2) test.</p><p><b>RESULTS</b>MUC1 mRNA expression was identified for twenty-six lymph nodes (15.7%), in eighteen patients (42%) who were diagnosed as having nodal micrometastasis. TNM staging for these patients was up-regulated from stages I-II(A) to stages II(B)-III. Relapse disease was found in nine patients with lymph nodes micrometastasis and three patients without nodal micrometastasis (P < 0.05).</p><p><b>CONCLUSION</b>Early tumor relapse after radical surgery in the patients with pN(0) esophageal cancer might be correlated with nodal micrometastasis.</p>