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Objective@#To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.@*Methods@#The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively.@*Results@#Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(QR): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups.@*Conclusion@#Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.
ABSTRACT
Objective@#To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.@*Methods@#The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively.@*Results@#Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(QR): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups.@*Conclusion@#Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.
ABSTRACT
Objective To investigate the effects of peri-operative enteral nutrition (EN) and antibiotics on intestinal flora balance in patients with esophageal carcinoma.Methods Sixty patients were randomly divided into six groups:Group B,treated with antibiotics for 3 days and supported with EN before and after operation; Group C,treated with antibiotics for 3 days and supported with parenteral nutrition (PN) before operation and EN after operation ; Group D,treated with antibiotics for 3 days and supported with PN before and after operation ; Group E,treated with antibiotics for 7 days and supported with EN before and after operation; Group F,treated with antibiotics for 7 days and supported with PN before operation and EN after operation ; and Group G,treated with antibiotics for 7 days and supported with PN before and after operation.The first stool after surgery was obtained and tested for Bacteroides,Bifidobacterium,Lactobacillus,Escherichia coli,and Enterococcus.Ten healthy adults were enrolled as the blank control group.The numbers of the flora and ratio of Bifidobacteria to Enterococci (B/E) were compared.Complications such as incision infections,lung infections,and anastomotic fistula were recorded.Results The numbers of Bifidobacterium [(10.59 ± 0.39) vs.(10.88 ± 0.10) lg10n/ml,P =0.186),Lactobacillus [(8.59±0.31) vs.(8.72 ±0.22) lg10n/ml,P=0.534],Escherichia coli [(8.43 ±0.50) vs.(8.67 ±0.24) lg10n/ml,P=0.266],Enterococcus [(7.40 ±0.61) vs.(7.78 ±0.16) lg10n/ml,P =0.111],and B/E value [(1.2589 ± 0.0644) vs.(1.2560 ± 0.0330),P =0.825] in the Group B were not significantly different from the blank control group.The numbers of Bacteroids [(11.08 ± 0.48),P =0.139 ; (9.23 ± 0.42),P =0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000; (8.05±0.53),P=0.000vs.(11.36±0.48) lg10n/ml],Bifidobacterium [(10.19 ±0.49),P=0.062; (9.00 ±0.52),P=0.000; (9.31 ±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99 ±0.56),P =0.000 vs.(10.59±0.39) lg10n/ml],Lactobacillus [(7.99 ± 0.58),P =0.006 ; (6.84 ± 0.47),P =0.000 ; (7.72 ± 0.35),P =0.000 ; (6.93 ±0.43),P =0.000; (5.93 ±0.76),P=0.000 vs.(8.59 ±0.31) lg10n/ml],Escherichia coli [(8.19 ±0.43),P=0.258; (7.93±0.60),P=0.020; (7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P =0.000 vs.(8.43 ± 0.50) lg10n/ml],and Enterococcus [(6.90 ± 0.54),P =0.037 ; (5.89 ± 0.68),P =0.000; (6.20±0.52),P=0.000; (5.91 ±0.39),P=0.000; (5.14±0.58),P=0.000 vs.(7.40±0.61) lg10n/ml] of groups C,D,E,F,and G decreased compared with those of the Group B.The values of B/Ein the D and G groups decreased significantly when compared to the blank control group (1.1433 ±0.1350,P =0.025 ; 1.0706 ± 0.1413,P =0.000 vs.1.2560 ± 0.0330).The incidences of pulmonary infections (x2 =3.647,P =0.601) and anastomotic leak (x2 =5.000,P =0.416) among all groups were not significantly different.Conclusions EN applied 3 days before surgery and after surgery is beneficial for maintaining the balance of intestinal flora.Long-term administration of antibiotics may cause dysbacteriosis and even increase complications.