Comparison of the short-term outcomes of surgical treatment for non-small cell lung cancer via video assisted thoracoscopic surgery and open thoracotomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the short-term outcomes of surgical treatment for non-small cell lung cancer (NSCLC) by video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT).</p><p><b>METHODS</b>Data of 737 consecutive NSCLC patients who underwent surgical treatment for non-small cell lung cancer by video-assisted thoracoscopic surgery and 630 patients who underwent pulmonary resection via open thoracotomy (as controls) in Cancer Institute & Hospital, Chinese Academy of Medical Sciences between January 2009 and August 2011 were retrospectively reviewed. The risk factors after lobectomy were also analyzed.</p><p><b>RESULTS</b>In the 506 NSCLC patients who received VATS lobectomy, postoperative complications occurred in 13 patients (2.6%) and one patient died of acute respiratory distress syndrome (0.2%). In the 521 patients who received open thoracotomy (OT) lobectomy, postoperative complications occurred in 21 patients (4.0%) and one patient died of pulmonary infection (0.2%). There was no significant difference in the morbidity rate (P > 0.05) and mortality rate (P > 0.05) between the VATS group and OT group. In the 190 patients who received VATS wedge resections, postoperative complications occurred in 3 patients (1.6%). One hundred and nine patients received OT wedge resections. Postoperative complications occurred in 4 patients (3.7%). There were no significant differences for morbidity rate (P = 0.262) between these two groups, and there was no perioperative death in these two groups. Univariate and multivariate analyses demonstrated that age (OR = 1.047, 95%CI: 1.004 - 1.091), history of smoking (OR = 6.374, 95%CI: 2.588 - 15.695) and operation time (OR = 1.418, 95%CI: 1.075 - 1.871) were independent risk factors of postoperative complications.</p><p><b>CONCLUSIONS</b>To compare with the NSCLC patients who should undergo lobectomy or wedge resection via open thoracotomy, a similar short-term outcome can be achieved via VATS approach.</p>

The rule of lymph node metastasis of adenosquamous carcinoma of the lung / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the rule of lymph node metastasis of adenosquamous carcinoma of the lung.</p><p><b>METHODS</b>The data of 361 surgically treated patients with adenosquamous carcinoma of the lung from October 1965 to June 2003 were collected and retrospectively reviewed. The classification of regional lymph node stations and TNM stage were determined according to the UICC criteria (1997). The route and patterns as well as influencing factors of lymph node metastasis were analyzed by SPSS 10.0 software. The median follow-up period was 5.5 years (range, 1.4 to 23.4 years).</p><p><b>RESULTS</b>The analysis of the route of mediastinal lymph node metastasis in the 361 cases showed that the tumor originated in the left upper lobe firstly metastasized to station 5 (A-P window), tumor in the right upper lobe to the station 4 (lower paratracheal), then secondly to station 7 (subcarinal), lastly to station 3 from the tumor in the left upper lobe or to the station 2 from the tumor in the right upper lobe. It was found that the tumors originated from the lower lobe, firstly metastasized to station 7, secondly to station 9 or 4 from the right lobe; or station 5 from left lower lobe, lastly to station 3 or 2 in the mediastinum. For the tumor in the middle lobe, mainly metastasized to station 7, 4 and 2. The skip mediastinal lymph node metastasis but N1 negative most commonly metastasized to station 7, then to station 4 from the tumor in the right lung and 5 from the tumor in the left lung. The prognosis of patients with a single skipping metastasis to mediastinal lymph node (N1-, SMLN) was better than that in the other patients with mediastinal lymph node metastases.</p><p><b>CONCLUSION</b>The lung cancer growing in a different location has a different route and skipping metastasis to mediastinal lymph nodes. The patterns of lymph node metastasis affect prognosis. The prognosis of patients with single skipping metastasis to mediastinal lymph nodes but negative pulmonary hilar lymph node is better than that in the other patients with multiple station mediastinal lymph node metastases. The "N1-, SMLN" pattern ought to be considered as a special lymph nodal metastasis with better prognosis.</p>

Comparison of clinical and surgico-pathological TNM stage of 2007 lung cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical (c-TNM) and postoperative surgico-pathologic staging (p-TNM) of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer.</p><p><b>METHODS</b>We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal ultrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated.</p><p><b>RESULTS</b>In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate (55.2%) of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9%, while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-IV stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-M0, providing the possibility of resectional surgery depending on the status of T and N.</p><p><b>CONCLUSION</b>For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.</p>