A retrospective comparative study of continuous pumping for home enteral nutrition after esophagectomy / 中华外科杂志

Objective@#To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy.@*Methods@#The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ2 test, Fisher exact test and t test, respectively.@*Results@#Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ2=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ2=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ2=39.167, P=0.000).@*Conclusions@#Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.

Exploration of Postoperative Follow-up Strategies for Early Staged NSCLC Patients on the Basis of Follow-up Result of 416 Stage I NSCLC Patients after Lobectomy / 中国肺癌杂志

BACKGROUND@#Currently, there is no consensus on the follow-up strategy (follow-up time interval and content) of non-small cell lung cancer (NSCLC) in the world, and the relevant clinical evidence is also very limited. In this study, we aimed to summarize the recurrence/metastasis sites and timings of stage I NSCLC patients based on their follow-up data, aiming to provide a basis of follow-up time interval and content for this group of patients.@*METHODS@#We retrospectively analyzed the 416 stage I NSCLC patients that underwent continuous anatomic lobectomy between Jan. 2000 to Oct. 2013 in our prospective lung cancer database. According to the recurrence/metastasis sites and timings, the long term follow-up time interval and content were explored.@*RESULTS@#The 5-yr disease free survival (DFS) and overall survival (OS) in the whole group were 82.4% and 85.4%, respectively. There were 76 cases (18.3%) had recurrence/metastasis during follow-up, among which the most frequent site was pulmonary metastasis (21 cases, 5.0%), followed by brain metastasis (20 cases, 4.8%), bone metastasis (12 cases, 2.9%), and mediastinal lymph node metastasis (12 cases, 2.9%). Among the factors that could influence recurrence/metastasis, patients with pT2a suffered from a higher recurrence/metastasis rate compared to patients with pT1 (P=0.006), with 5-yr DFS being 73.8% and 87.3%, respectively (P=0.002), and the 5-yr OS being 77.7% and 90.3%, respectively (P=0.011).@*CONCLUSIONS@#The commonest recurrence/metastasis sites of stage I NSCLC after anatomic lobectomy are lung, brain and mediastinal lymph nodes, the risk of recurrence/metastasis within 2 years were equal to that between 3 years and 5 years. The follow-up frequencies and content within 2 years could be adjusted according to T stages.

Analysis of Prolonged Hospitalizations (Longer than 7 days): 115 Lung Cancer Patients after Video Assistant Thoracic Surgery (VATS) / 中国肺癌杂志

BACKGROUND@#Thoracoscopic surgery has gradually become the major procedure for lung cancer surgery in our department. Its characteristics are minimal trauma and quick recovery, which make approximately 90% of patients discharge from the hospital after surgery. However, the postoperative complications still happen now and then. We analyzed the patients who had been hospitalized for longer than 7 days after thoracoscopic lung cancer surgery, aiming to summarize the types and risk factors of complications, and improve postoperative safety of patients.@*METHODS@#The data were come from the prospective database of Thoracic Surgery Unit One in Peking Cancer Hospital, and patients that underwent thoracoscopic pulmonary surgery between Jan. 2010 and Dec. 2014 with length of stay more than 7 days were included in the study. The classifications of the complications were investigated and graded as mild or severe complications according to modified Claviengrading, the relationship between clinical factors and degrees of complications was also analyzed.@*RESULTS@#The hospitalization of 115 cases were longer than 7 days after surgery, accounting for 10.3% (115/1,112) of the whole patients that underwent surgery during the same period. Eighty-one cases had mild complications, accounting for 7.3% (81/1,112) of the whole cases that underwent surgery during the same period and 70.4% (81/115) of the cases with prolonged length of stay; the proportions of severe complications in both groups were 3.1% (34/1,112) and 29.6% (34/115), respectively; and the proportions of complications that caused perioperative deaths were 0.18% (2/1112) and 1.7% (2/115), respectively. Among all the postoperative complications, the most common was air leakage for more than 5 days after surgery, with a total of 20 cases (1.8% and 17.4%). The other common complications were: atelectasis (19 cases, 1.7% and 16.5%), pulmonary infection (18 cases, 1.6% and 15.7%), etc. The less common complications was bronchopleural fistula (4 cases, 0.36% and 3.5%) with very high risk, and 2 cases died perioperatively due to the combination of acute respiratory distresssyndrome (ARDS). In the clinical factors, only preoperative low pulmonary function (FEV1%<70%) was the potential risk factor for postoperative severe complications (45.8% vs 23.6%, P=0.038). There was no significant difference either regarding the 5 year disease free survival or the 5 year overall survival between mild complication group and severe complication group, with 5 year DFS being 52.2% and 51.9%, respectively (P=0.894) , and 5 year overall survival being 64.0% and 53.5%, respectively (P=0.673).@*CONCLUSIONS@#Continuous postoperative air leakage, atelectasis and pulmonary infections were the major causes for prolonged hospitalization after thoracoscopic surgery for lung cancer, and bronchopleural fistula was the most perilous complications. Patients with low preoperative pulmonary function were more likely to have severe postoperative complication, however, this would not influence the long term survival of the patients.

Postoperative 30-day mortality may underestimate the risk of esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the mortality of esophagectomy in our series and compare the different mortalities based on 30-day deaths and 90-day deaths postoperatively.</p><p><b>METHODS</b>A total of 954 patients undergoing esophagectomy by single-surgeon-team between January 2000 and December 2012 from our prospective database were enrolled. The mortalities based on 30-day and 90-day deaths postoperatively were compared, and the causes of deaths within 30 days and 90 days were analyzed.</p><p><b>RESULTS</b>Among all these 954 patients, a total of 20 postoperative deaths(2.1%) were observed: 11 within 30 days(1.1%) and 9 between 30 and 90 days after surgery(1.0%). The reasons for deaths within 30 days were as follows: 3 for respiratory failure related to anastomotic leakage,1 for bleeding after stenting due to anastomotic fistula, 1 for sepsis, 3 for respiratory failure from presenting preoperative respiratory morbidities, 2 for cardiac arrest caused by preoperative heart disorder, and 1 for multiple organ failure caused by early adjuvant chemotoxicity. The reasons for deaths between 30 and 90 days were as follows: 1 for respiratory failure related to anastomotic leakage, 1 for cardiac arrest from preoperative heart disorder, 1 for cerebrovascular accident, 1 for liver failure from liver cirrhosis presenting preoperatively, 1 for renal failure after operation, 1 for tumor progression and 2 for unknown reasons.</p><p><b>CONCLUSION</b>Since postoperative mortality calculated based on 30 days deaths postoperatively may underestimate the risk of esophagectomy, mortality calculated based on 90 days may be a better option.</p>

Anesthesia for esophagectomy / 中华胃肠外科杂志

Esophagectomy is one of the most complicated procedures. Satisfactory anesthesia not only ensures the safety in terms of low morbidity and mortality postoperatively, but also one of the potential factors relevant to long-term survival. Most of physicians, however, ignore the significance of anesthesia. This article focuses on the recent advances of anesthesia for esophagectomy in preoperative preparation for induction, rapid-sequence induction, one-lung ventilation, fluid management during surgery and postoperative early extubation and analgesia.

Analysis of 19 cases undergoing reoperation for complications following esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the cause and the management of treatment and prevention of reoperation following esophagectomy.</p><p><b>METHODS</b>Clinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them, 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized.</p><p><b>RESULTS</b>The indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis (n=1). All the 19 patients were successfully cured without perioperative deaths and further complications.</p><p><b>CONCLUSIONS</b>The indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.</p>

Inhibition mechanism of vitamin D in lung cancer / 国际肿瘤学杂志

In recent years a large number of studies have been conducted to investigate the role of vitamin D and its metabolites in cancer.However,the picture for lung cancer is not clear at the present time.There are three integral components of the vitamin D pathway:the vitamin D receptor(VDR),CYP27B1 and CYP24A1.Besides,vitamin D inhibits the carcinogenesis of lung by indirectly influencing IGF signaling,TGF-β signaling,and Wnt/β-catenin signaling pathway.Their differential expressions in normal lung tissue and lung cancer offer clues and lay the foundation for research of the inhibitory function in lung cancer pathogenesis.

Epidemiology study on the incidence and distribution of the patellofemoral arthritis in 50-year-old people in Wuchuan region of Inner Mongolia of China / 中华风湿病学杂志

Objective To identify the diagnostic criteria and investigate the incidence and distribution of the patellofemoral arthritis in aged people in Wuchuan region of the Inner Mongolia of China. Methods A population-based cross-sectional survey was conducted among 1030 residents aged 50 years and over of Wuehuan County, Inner Mongolia. Survey participants, mostly farmers, reported heavy physical activity, completed an interview-based questionnaire and Skyline View weight-bearing films were evaluated for KeU-gren and Lawrence (K/L) grade. Radiological patellofemoral arthritis (RPFA) and symptomatic patellofemoral arthritis (SPFA) were defined. Statistical package SPSS 14.0, crosstabs chi-squae test and Excel were adopted for statistical analysis. Results One thousanod and twenty-five participants were included in this study and 2050 knee joint Skyline View weight-bearing films were analyzed. The incidence of RPFA was 8.72%(6.8% in men, and 10.5% inwomen). The incidence of SPFA was 6.33% (4.8% in men, and 8.0% in women).The RPFA incidence of age groups 50～, 60～,≥70 was 3.8%, 10.6%, 22.9% respectively, while the incidence of SPFA was 2.7%, 7.7%, 17.3% respectively. The Three age groups' SPFA/RPFA was 71.7%, 72.0%, 75.6% respectively. The incidence of RPFA was 6.00/0, 7.3%, 11.0%, 11.3%, and the incidence of SPFA was 4.2%,5.2%, 7.3%, 9.6% and the four SPFA/RPFA was 70.0%, 71.3%, 66.7%, 84.8% in people whose BMI was less than 18.5, 18.5～, 23.0～ and higher than ≥25.0 kg/m~2 respectively, 73.6% people had joint pain among RPFA.Conclusion The prevalence of symptomatic patellofemoral arthritis in the rural areas of China is 6.8%, the incidence of that in women is higher than in men, and elder people suffer a high incidence. And the heavier the people are, the higher the incidence of patellofemoral arthritis.